MUST IT ALWAYS BE TYPHOID FEVER?

Source:  MUST IT ALWAYS BE TYPHOID FEVER?    Tag:  typhus fever diagnosis
A young lad met me on my way back from work; “Good day sir, he said; I have been sick for up to two weeks now. My mouth was bitter and I had a fever. I was treated for malaria initially and after which I was placed on several antibiotics but I still feel sick and my mouth is bitter” “They said I have typhoid”. “Who said so?”I queried? Ah! Doctor, I went to the Laboratory and they did Widal test for me and it was high. Then I laughed and replied jokingly; MUST IT ALWAYS BE TYPHOID FEVER?
It has become a trend in our society to label everyone with a fever as having typhoid fever. It is even worse when the diagnosis is being made straight from the laboratory without consulting a doctor. It has become obvious that some doctors are involved in this menace of diagnosing every fever as typhoid fever, hence sustaining the ugly trend of the so called typhoid/malaria/typhoid syndrome.
It is important to note that Widal test is not meant to be diagnostic for typhoid fever.  Where Widal test is used, the test has to be done serially. It is a rising titre in the antibody levels that is suggestive of an acute infection and not just a single antibody titre.Salmonella, which is the cause of typhoid fever infection is endemic in our setting and most people will have a raised typhoid antibody levels in their blood and thereby giving a false impression. Here are some of the facts concerning typhoid fever.
WHAT IS TYPHOID FEVER?
Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. Typhoid fever is rare in industrialized countries. However, it remains a serious public health threat in the developing world, like ours.
When treated with antibiotics, most people with typhoid fever feel better within a few days; although a small percentage of them may die of complications.
Vaccines against typhoid fever are available, but they're only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.
HOW IS TYPHOID FEVER SPREAD?
Fecal-oral transmission route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected.
 Salmonella typhi is passed in the feces and sometimes in the urine of infected people. Infection can be contracted when food handled by someone with typhoid fever who hasn't washed carefully after using the toilet is eaten. You can also become infected by drinking water contaminated with the bacteria.
Therefore, typhoid fever is more common in areas of the world where
hand washing is less frequent and water is likely to be contaminated with sewage.
Typhoid carriers
A small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. They shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves. They are referred to as chronic carriers.
WHAT ARE THE SIGNS AND SYMPTOMS OF TYPHOID FEVER?
Persons with typhoid fever usually have a sustained fever as high as 39° to 40° C, headache, abdominal pain, and either constipation or diarrhea. Other features may include weakness, loss of appetite, and rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have
samples of stool, blood or urine tested for the presence of S. Typhi.
WHAT IS THE TEST THAT CAN BE DONE TO DIAGNOSE TYPHOID FEVER?
Samples of blood, stool, urine or bone marrow can be tested. (CULTURE).A bone marrow culture is often the most sensitive test for salmonella typhi
WHAT ARE THE COMPLICATIONS OF TYPHOID FEVER?
Ø  Intestinal bleeding or perforation
Ø  Inflammation of the heart muscle (myocarditis)
Ø  Inflammation of the lining of the heart and valves (endocarditis)
Ø  Pneumonia
Ø  Inflammation of the pancreas (pancreatitis)
Ø  Inflammation of the gallbladder (cholecystitis)
Ø  Kidney or bladder infections