Vishnupriya Table of Contents
Enteric Fever Overview
Enteric fever, or typhoid fever, is a bacterial infection caused by the Salmonella Typhi bacteria. These pathogenic germs primarily inhabit the small intestine of the human body, where they multiply and lead to fever. If a person experiences a fever lasting more than three days, it may indicate typhoid fever, a term widely recognized by the public.
Causes of Enteric Fever
The Salmonella Typhi bacteria reside in the patient’s small intestine and related lymphoid tissues. They are excreted from the body through feces and urine, dispersing into the soil.
Transmission Pathways
Millions of these pathogens thrive in unsanitary locations and public latrines. Flies that frequent such areas can carry the bacteria back to homes, contaminating food and water. When a person consumes these contaminated substances, they risk contracting enteric fever.
Disease Carriers
The disease can also spread from individuals who have recovered from enteric fever but still harbor the bacteria in their bodies, known as “carriers.” Even though these carriers do not exhibit symptoms, the bacteria may remain in low numbers for several months, primarily residing in the gallbladder. Carriers can shed small amounts of the bacteria through their urine and feces, inadvertently transmitting them to others, particularly through flies. This unnoticed spread contributes to the ongoing transmission of enteric fever.
Alternative Routes of Transmission
The germs responsible for enteric fever can survive in water for only two days; however, they can persist in moist soil for over two months. Therefore, consuming vegetables and fruits grown in contaminated soil without proper cleaning or cooking increases the risk of infection.
Additionally, these bacteria can be present in milk, where they may multiply. Individuals who drink unboiled or inadequately warmed milk are at higher risk of contracting the fever. The bacteria can also survive for months in cold foods like ice and ice cream, especially in unsanitary canteens, where patrons may develop gastroenteritis.
Affected Age Groups
People of all ages, from children to the elderly, can contract gastroenteritis; nonetheless, children between the ages of five and ten are particularly vulnerable.
Disease Development
The pathogens enter the body through contaminated food, impure drinking water, or unsanitary milk, subsequently mixing with the bloodstream via the small intestine. They multiply and then return to the small intestine, settling in the lymphatic tissue. The bacteria specifically target the Peyer’s patches, which are critical for intestinal defense. This attack causes the intestinal secretory tissues to swell and leads to the formation of small sores, ultimately resulting in fever.
Incubation Period
Typically, enteric fever manifests approximately ten to fourteen days after the bacteria enter the body.
Symptoms
On the first day, the disease presents like Sada Ranak fever, with symptoms including fever, headache, body aches, and leg pain. The fever tends to increase gradually over the next four days, typically peaking at night and subsiding by morning. Appetite decreases, and nausea and vomiting become quite bothersome, making it difficult to eat. Patients may also experience stomach pain, cough, and a runny nose.
From the fifth day, vomiting and headaches intensify, accompanied by fatigue and dizziness. Adults may suffer from constipation, while children may have diarrhea.
By the seventh day, a white coating resembling flour develops on the tongue’s surface. Red rashes and rose-colored spots appear on the abdomen and back but usually fade within three days.
On the tenth day, the spleen may become swollen, and the stomach may feel salty, with significant abdominal pain. Failure to receive treatment by this time can lead to more severe consequences.
Complications
As the fever progresses, it may increase to the point of seizures or loss of consciousness. Dehydration can occur, leading to decreased blood pressure.
In some cases, hemorrhaging may develop in the small intestine during the third week after the onset of the disease, resulting in blood in the stool. Intestinal perforations can also occur, leading to blood loss in stool and possible vomiting of blood. These developments can place the patient in shock, posing a life-threatening risk.
Septicemia may arise due to increased toxicity from enteric fever in the bloodstream, leading to severe complications such as pneumonia, myocarditis, osteoarthritis, gallbladder inflammation, kidney inflammation, encephalitis, and osteomyelitis, any of which can be fatal.
Diagnosis
A blood test is crucial for confirming typhoid fever, as patients typically show low white blood cell counts (leukopenia). Antibodies associated with the disease can be detected through the Wil Blood Test, which can confirm enteric fever. However, a culture test is the most reliable method for accurate diagnosis.
Treatment Method
There are various antimicrobials available for treating enteritis, with prominent options including chloramphenicol, cotrimoxazole, amoxicillin, ciprofloxacin, ofloxacin, and ceftriaxone sodium. When taken as prescribed by a doctor for about two weeks, these medications can completely cure the disease. It is important to note that fever usually reduces only after the sixth day of treatment. Probioxacilin, administered for four consecutive weeks, can also effectively cure the disease. In some cases, surgical intervention to remove the gallbladder (cholecystectomy) may be necessary.
Patient Care
The patient should be isolated in a separate room, ensuring that both the patient and caregivers maintain excellent hand hygiene. This is crucial, as there is a high risk of germs spreading through unclean hands.
If the patient appears lethargic or dehydrated, intravenous fluids should be administered as needed. According to a doctor’s advice, the patient can consume oral rehydration solutions such as Aurisikkanji, fruit juice, milk, glucose, water, and nutritional drinks.
Once the patient has been fever-free for three consecutive days, liquid intake can be gradually reduced, and solid foods can be introduced. Suitable foods include idli, idiyappam, roti, and biscuits. After one week, the patient can return to a regular diet.
Antibiotics
There are three types of preventive medications for typhoid fever. The first two types are administered via injection, while the last is an oral tablet. A single injection can protect an individual from Cook’s enteritis for three years. Individuals averse to needles can take preventive pills; by consuming three tablets (one every other day before meals), they can avoid enteric fever for three years.
Prevention Methods
It is important to note that these medications alone are not sufficient to prevent typhoid fever. Maintaining personal hygiene and environmental cleanliness is essential. This includes cooking food properly, storing it safely, boiling water and milk thoroughly, cleaning vegetables, keeping food covered to prevent contamination, minimizing the consumption of cold foods, avoiding unclean eateries, refraining from using public spaces as latrines, and keeping flies away from living areas. Implementing good sanitation practices, such as spraying for flies, can help reduce the spread of enteric fever.
