The patient will feel very ill, the abdomen is often distended, and there may be a rash which is sparse and difficult to see on a dark skin.
In the third week the patient will be very ill and in semicoma, thus it may be delirious.
There may be some damage to the heart (toxic myocarditis) and the pulse is now rapid and feeble. At this stage, the intestinal haemorrhage or perforation may occur, and femoral thrombosis or pneumonia.
In the fourth week, if the patient has so far survived, there will be the begining of gradual improvement with very slow disappearance of the symptoms over several weeks. There is a prolonged convalescence and relapses are very common.
This description refers to the untreated case.
Typhoid Disease Cause
A bacterium called Salmonella typhi. This is excreted both by patients and by symptomless carriers (persons who have had the disease and recovered, but continue to excrete the bacteria). This is the one 'Salmonella' that is never spread by animals as it only comes from man.Typhoid Route
The bacteria are excreted in the faeces and/or urine, both by patients and carriers, and may contaminate water supplies.As very few bacteria are needed to cause the disease in any susceptible person, as little as one excreta containing Salmonella typhi can, by contaminating the water supply, it could cause several hundred cases.
Not only can people ingest the the germ by drinking contaminated water but also by drinking milk indirectly contaminated by the water, or by eating food which has been contaminated by water.
Typhoid is one of the disease which lead to common-source epidemics, and it is also likely to occur in areas with poor sanitation. Periurban slums, prisons, overcrowded boarding-schools refugee settlements, are liable to have epidemics of typhoid.
Typhoid Susceptibles
All people of all ages are susceptible, except those who have had an attack within the past few years, or those who have been recently vaccinated against typhoid.Typhoid Prevention
1. Municipal chlorinated piped water supplies.2. Only chlorinated or boiled water should be used for the preparation of food, or for cleaning vessels containing food.
3. In rural areas where there is no possibility of chlorinated water supplies, water should preferably be obtained from bore holes, or if not, at least the water should be boiled before use.
4. Milk and ice-cream should be pasteurized efficiently. Food hygiene generally!
5. There is a vaccine avialable against typhoid and also against paratyphoid. This vaccine does not, however, confer complete immunity on all who receive it. It has to be given three times with monthly intervals, and a further disadvantage is that it has to be repeated every 3 years.
Yet another disadvantage is that it causes a fever and a swollen painful arm or leg depending on where the vaccine is injected.
Because of the disadvantages, the vaccine is not in common use for routine immunization of children.
The secured children could however, be immunized as their parents are able to balance the risks of typhoid against the disadvantages of the vaccine. Moreover, it may be used routinely for armies, medical staff, and tourists.
