Typhoid fever disease is a global health phenomena or problem with approximately 20 million incidents and 700,000 adult deaths every year. Notably, a huge portion of these cases and deaths occur in developing countries, especially in South East Asia and Indian subcontinent. While the infection was traditionally treated with ampicillin, chloramphenicol, and trimethoprimsulfamethoxazole, serious public health program has emerged in the past decades because of the widespread emergence of antibiotic resistant Salmonella typhi or S.typhi. Moreover, typhoid fever disease caused by MDR organisms can also be considered as a significant public health and therapeutic issue. This is primarily because there are a huge number of cases of MDR typhoid fever that occur in childhood and are coupled with considerably high mortality and morbidity rates. Since the disease has developed to become a significant public health issue in the past few decades, it’s important to conduct a research about it and document findings. This will help in not only tackling the significant public health issue but also promoting good health among populations. This study will also be important in identifying the most effective treatment method for addressing typhoid fever disease.
As previously mentioned, typhoid fever disease is a major public health issue across the globe that is caused by the bacterium Salmonella enteric serotype typhi. The severity of the disease is evident in the fact that more than 20 million cases and at least 700,000 deaths are reported annually (Hamad et. al., 2011, p. 100). These cases and deaths are specifically prevalent in developing nations, particularly those in South East Asia and Indian subcontinent. The main reason for the prevalence of the disease in these regions is because of the problem of inadequate sewage disposal, flooding, and unsafe drinking-water. After infection by the bacterium S.typhi or MDR organisms, the disease is spread basically through contaminated water and food. Generally, infection with S.typhi contributes to approximately 16 million incidents of typhoid fever across the globe annually. The bacterium is also attributed to between 200 and 400 laboratory-confirmed cases or incidents in America. Notably, there has been a significant increase in the number of typhoid fever cases among travelers from 30% to 75%. While treatment with antimicrobial agents has reduced mortality rates from the disease in the United States, the worldwide emergence of antibiotic resistant S.typhi threatens this success (Steinberg et al., 2004, p. 186).
Typhoid fever disease is an actual diagnostic challenge because of the protean manifestations of the disease. The bacterium causing typhoid fever disease, S.typhi, has been a significant human pathogen for many years. This bacterium actually thrives in conditions of crowding, poor sanitation, and social chaos. While untreated typhoid fever may progress to severe cases like delirium and death within a month of onset, the advanced stages of the disease contributes to the patient’s level of consciousness being actually clouded.
The signs and symptoms of typhoid fever illness are non-specific since the organism may not be separated from blood even under the best conditions. However, the signs and symptoms of the disease are more likely to develop gradually in a period of one to three weeks after exposure to the illness. During the first week of illness, an individual is likely to experience fever that starts low and gradually increases on a daily basis, weakness and fatigue, headache, loss of appetite, diarrhea or constipation, dry cough, abdominal pain and rash.
If a person does not receive treatment for the disease during the initial stage, it may develop to the second stage where he/she is likely to become very ill. During this period, which is the second week of illness, the patient is likely to experience constant high fever, extremely distended abdomen, diarrhea or severe constipation, and significant weight loss.
These signs and symptoms worsen during the third week of illness where the patient may become delirious and lie motionless and exhausted with the eyes half-closed. Notably, the individual is also likely to develop life-threatening complications during the third week of illness. On the fourth week of illness, improvement may come slowly as the fever declines gradually until the individual’s temperature turns to normal between a week and 10 days. However, the previous signs and symptoms of the disease can return even after two weeks after the fever has decreased.
As a result of these clinical features of the disease, an individual should see a physician immediately after suspecting that he/she has the disease. In this case, the patient should consider consulting a physician who focuses on infectious diseases. This is because a specialist in this field may be able to recognize and treat the disease faster than a physician who isn’t trained in these areas (“Symptoms,” n.d.).
The effective management of typhoid fever is usually dependent on the speedy and accurate diagnosis of the disease. Generally, the laboratory diagnosis of the disease requires the identification and isolation of the Salmonella enterica serotype typhi. However, this laboratory capability is usually limited in many places where the disease is endemic. Moreover, the diagnosis of the disease on clinical grounds is a complex process since the signs and symptoms are diverse and similar to those of other common febrile diseases like malaria.
Notably, the laboratory diagnosis of the disease is usually centered on the isolation of serotype Typhi from blood, which remains the most common method. Arjunan & Al-Salamah (2010) state that the simpler techniques for diagnosis of typhoid fever would be quite advantageous and beneficial, particularly in developing nations where the disease is endemic (p. 593). One of the major techniques that have been suggested is serological tests as rapid and easy alternative to culturing for the diagnosis of typhoid fever illness. There are classical and serological methods that have been used to identify S. Typhi such as culturing and slide agglutination respectively. The other serological methods used in the diagnosis of typhoid fever disease are Widal test and Polymerase Chain Reaction (PCR). While these methods can offer highly sensitive results for quantitative and qualitative analysis, they are usually quite difficult and time-consuming to perform (Mitra, 2009, p. 109).
In efforts to address the drawbacks of the classical and serological methods for diagnosing typhoid fever disease, alternative methods have been developed under the biological molecular analysis. These methods include surface Plasmon resonance, enzyme immunoassay, and electrochemical immunoassay. In the past few years, electrochemical immunoassay has received considerable attention because of its intrinsic simplicity, miniaturization, high sensitivity, and inexpensive instrumentation in identifying S. typhi. The sensitivity of this method or technique has been enhanced by the development of nanotechnology, nano-quantum dots, and several nanoparticles.
For a long period of time, the most effective therapy for typhoid fever has been antibiotic treatment or therapy. Through this method, the most commonly prescribed antibiotics are ceftriaxone (rocephin) and ciprofloxacin (cipro). Cipro is commonly prescribed for non-pregnant adults in the United States whereas rocephin is an injectable antibiotic prescribed for pregnant women and children who may not be candidates for cipro. In addition to the possibility of these drugs to cause various side effects, their long-term use can contribute to the emergence of antibiotic-resistant bacteria strains. The main side effect of the drugs is that they are likely to contribute to a high rate of health deterioration and relapse after a period of improvement. The other most commonly used antibiotics for treatment of the disease are pefloxacin, ofloxacin, and third-generation of cephalosporins like cefotaxime. However, there are other supportive therapy procedures that have been adopted to help in managing the symptoms of the typhoid fever disease. These supportive therapy procedures are drinking fluids to prevent dehydration brought by extended diarrhea and fever and eating a healthy diet to replace lost nutrients during the sickness. For patients who are extremely dehydrated, they may need to receive fluids via a vein in the arm.
The emergence of antibiotic-resistant Salmonella bacterium has contributed to the need for effective treatment procedures since the bacterium has become a major threat to the society and spread of the disease. Actually, several efforts have been carried out by various groups of scientists to develop and efficient vaccine against the bacterium (Marathe et. al., 2012, p. 163). This is particularly because the emergence of this multidrug resistant bacterium has made the treatment of the disease more complicated and difficult. Currently, there are two approved vaccines for typhoid fever i.e. A live attenuated S.typhi strain and a subunit, which are both commercially available. Moreover, there are ongoing measures to develop typhoid vaccine, especially with the advancement of Vi-polysaccharide conjugate vaccine.
Therefore, typhoid fever disease is treatable, especially through the use of antibiotic and supportive therapy procedures. Actually, these treatment methods have significantly reduced the mortality rates associated with the disease to utmost 2%. Through the use of antibiotic therapy, there is usually an improvement in the symptoms of typhoid fever disease within two days and considerable recovery after a week.
While typhoid fever disease remains a rare disease in developed countries like the United States and an endemic in developing countries, it continues to contribute to substantial morbidity among affected patients. The severity of the disease is fueled by the fact that proper treatment of patients with the disease through efficient antibiotic therapy is increasingly becoming more complicated by strains resistant to the existing antimicrobial agents (Lynch et al., 2009). Generally, this disease is considered as an acute, life-threatening febrile illness that can cause severe health effects if it remains untreated.
As a potentially fatal multi-systemic disease, typhoid fever illness is likely to result in severe cases when it’s left to develop. If the illness remains untreated, it’s likely to progress to intestinal hemorrhage, delirium, bowel perforation, obtundation, and even death within one month of infection. Moreover, the survivors of the disease are also likely to experience permanent or long-term neuropsychiatric complications.
Therefore, the possible estimated outcome of typhoid fever disease is long-term complications and even death. These outcomes are likely to occur if the patient is continually exposed to the risk factors that lead to the development of the disease. In addition to the exposure to risk factors, typhoid fever disease is also likely to be fatal if the patient does not take necessary measures to seek for treatment of the disease.
Typhoid fever disease is an acute, fatal illness that continues to be a major public health issue in developing countries, particularly in the Indian subcontinent and South East Asia. The development of the disease in these areas is generally attributed to the widespread poor sanitation and hygiene conditions.
Arjunan, M. & Al-Salamah, A.A. (2010, April 29). Typhoid Fever with Severe Abdominal Pain:
Diagnosis and Clinical Findings using Abdomen Ultrasonogram, Hermatology-cell Analysis and the Widal Test. Journal of Infections in Developing Countries, 4(9), 593-596. Retrieved from http://jidc.org/index.php/journal/article/download/1010/445
Hammad et al. (2011). Ceftriaxone vs. Chloramphenicol for Treatment of Acute Typhoid
Fever. Life Science Journal, 8(2), 100-105. Retrieved from http://www.lifesciencesite.com/lsj/life0802/14_4757life0802_100_105.pdf
Lynch et al. (2009, August 26). Typhoid Fever in the United States, 1999-2006. The Journal of the American Medical Association, 302(8), 859-865. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=184464
Marathe et al. (2012, February). Typhoid Fever & Vaccine Development: A Partially Answered
Question. Indian Journal of Medical Research, 135, 161-169.
Mitra, R. (2009, March). Nanotechnology and the Diagnosis of Typhoid Fever. Digest Journal of Nanomaterials and Biostructures, 4(1), 109-111. Retrieved from http://www.chalcogen.infim.ro/1Mitra-Rahul.pdf
Steinberg et al. (2004, July 15). Typhoid Fever in Travelers: Who Should be Targeted for Prevention? Clinically Infectious Diseases, 39, 186-191. Retrieved from http://cid.oxfordjournals.org/content/39/2/186.full.pdf
“Symptoms.” (2012, August 22). Typhoid Fever. Retrieved November 13, 2012, from http://www.mayoclinic.com/health/typhoid-fever/DS00538/DSECTION=symptoms
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