Typhoid fever, also known as Salmonella typhi or commonly just typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person.
The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacterium grows best at 37 °C/99 °F – human body temperature.
• gastric fever
• abdominal typhus
• infantile remittant fever
• slow fever
• nervous fever
• pythogenic fever.
With an estimated 16–33 million cases of annually resulting in 216,000 deaths in endemic areas, the World Health Organization identifies typhoid as a serious public health problem.
Its incidence is highest in children and young adults between 5 and 19 years old.
• Strongly endemic
• Sporadic cases
• characterized by a slowly progressive fever as high as 40 °C (104 °F)
• profuse sweating
• and nonbloody diarrhea.
• Less commonly, a rash of flat, rose-colored spots may appear
Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week.
• In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough.
• A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells.
• The classic Widal test is negative in the first week.
• In the second week of the infection, the patient lies with high fever in plateau around 40 °C (104 °F) and bradycardia.
• Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever".
• The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard.
• Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea soup.
• Constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender.
• The Widal reaction is strongly positive.
• In the third week of typhoid fever, a number of complications can occur:
• Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal.
• Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
• Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing
This carries on into the fourth and final week.
Diagnosis is made by
• Blood examination
• bone marrow examination
• stool cultures
• Widal test (demonstration of salmonella antibodies against antigens O -somatic and H-flagellar).
The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.
• Sanitation and hygiene are the critical measures that can be taken to prevent typhoid.
• Typhoid does not affect animals and therefore transmission is only from human to human.
• Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water.
• Careful food preparation and washing of hands are crucial to preventing typhoid.
• A vaccine against typhoid fever was developed
• Patient is dull besotted ,as if intoxicated
• Patient feels tired and bruised all over
• Restless and tosses in the bed
• There is peculiar delirium that the person is scattered and he tries to put all the things together
• There is extreme profound prostration
• Tongue has brown streak in the middle
• The discharges from the patient are extremely offensive
• There is extreme restlessness
• And muscular soreness
• The characteristic tongue is with triangular red tip
• The tongue is brown
• Low muttering delirium refuses to take medicine for fearof being poisoned
• Head ache with nose bleed often
• Diarrhea of yellowish brown stools with offensive odour
• Great soreness of the body
• Tired feeling,every exertion fatigues
• Splitting agonizing head aches worse from motion
• Fullness of head which is followed by nose bleed
• Delirium and imagines that he is not in the home and tries to go home
• Thirst for large quantities of water at longer intervals of time
• Sensitiveness in the region of epigastrium
• There is stupor an indifference to every thing
• They go to sleep while answering the questions
• Bruised feeling all over the body and searches for the soft place to be laid on
• Involuntary passage of stools and urine
• Offensiveness of discharges
The other frequently used remedies are