Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. It belongs to the Salmonella group which contains nearly 2,000 different types causing mild diseases such as food poisoning, through to the more serious disease of typhoid fever. Paratyphoid fever is a similar but less severe variant.
It is a common illness in the developing world, where it affects about 12.5 million people each year.
Typhoid fever occurs in most parts of the world except in developed countries such as the United Kingdom, Western Europe, USA, Canada, Australia, New Zealand and Japan. Therefore, if you are traveling to the developing world, you should consider taking precautions. Travellers to Asia, Africa, and Latin America are especially at risk.
The typhoid fever bacteria is carried in the bloodstream and intestinal tract of infected persons. A small number of persons, called carriers, recover from the fever but continue to carry the bacteria. Both ill persons and carriers shed the bacteria in their feces. Diagnosis requires medical opinion and examination of the blood.
You can get typhoid fever if you eat food or drink beverages that have been contaminated by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. 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.
The incubation period depends on the quantity of the bacteria swallowed and can vary from one to three weeks.
Persons with typhoid fever usually have a sustained fever as high as 39° or 40° C. They will also feel weak, have stomach pains, headache and loss of appetite. In some cases, patients have a rash of flat, rose-colored spots.
Treatment: Typhoid fever is usually treated with antibiotics such as ampicillin or ciprofloxacin which are very effective but should ideally be given under medical supervision. Hospital admission may be more appropriate abroad. Persons treated with antibiotics usually improve within 2 to 3 days, and deaths rarely occur. However, relapse is not uncommon and patients may develop the carrier state after treatment. It is therefore very important to have your stools examined on your return if you have been treated for typhoid abroad.
Without treatment this illness can be fatal!!. Persons who do not receive treatment may continue to have the fever for weeks or months, and as many as 20% may die from complications such as peritonitis resulting from perforation of the gut wall.
Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning to travel to a region where it exists, you should know about it and what steps you can take to protect yourself.
There are two basic actions that can help to protect you from typhoid fever:
1. Get vaccinated against typhoid fever.
2. Avoid risky foods and drinks.
Watching what you eat and drink when you travel is just as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhoea, cholera, dysentery, and hepatitis A.
Tetanus is a potentially fatal disease which is caused by an infection of the bacterium Clostridium Tetani. The bacteria enter the body through a wound where they grow and produce a powerful toxin which circulates in the blood and causes muscular rigidity and painful muscle contractions. Death is usually caused by respiratory problems and exhaustion.
Tetanus spores are present in soil worldwide and may be introduced into the body during injury through a puncture wound, burn or trivial, unnoticed wounds.
Tetanus can be contracted quite easily through a small wound such as a scratch through which the organism can get into the body. There have been reported cases of tetanus in which the patient cannot even remember the injury since it was so small and insignificant.
While vaccination has largely diminished the incidence of tetanus, the disease has not disappeared. If individuals are not fully immunized there is always the risk of tetanus developing in wounds contaminated by soil. The incubation period is between four and twenty one days, commonly around ten days.
The first sign of tetanus is when the patient may notice jaw stiffness and difficulty in opening the mouth (lock jaw).
Treatment: Requires medical supervision in hospital.
Prevention: All wounds, even minor ones should be thoroughly washed with clean water and soap taking particular care to remove all dirt and loose tissue.
Immunization against tetanus is highly protective and adults and children should ensure they are in date for it. Booster doses should be given at ten year intervals.
Booster doses in addition to five doses are not recommended except in the case of the treatment of a tetanus-prone wound.
The Department of Health advised in 2002 that tetanus vaccine is to be replaced by the combined tetanus/low dose diphtheria vaccine for adults and adolescents for routine use and for travel vaccination. Stocks of single tetanus vaccine are now exhausted and companies are no longer supplying this product.
Poliomyelitis, normally referred to as polio is caused by a virus which is spread from person-to-person primarily through facial contamination of food and water although it can also be spread by droplet transfer.
Initially, infection of the gut can spread to the spinal cord or brain where it can cause paralysis. In the days before widespread vaccination it tended to occur in epidemics.
Travelers who have not been immunized or whose immunity has waned are at risk if they are travelling to areas of the world where polio still occurs. ie. Nigeria, Niger, India, Pakistan and Afghanistan are particularly high risk.
In many cases infection with the polio virus is asymptomatic. When symptoms do occur, the onset of polio is sudden with fever, headache, nausea and vomiting as the virus multiplies in the gut. The virus then invades the blood stream and nervous system. Paralysis occurs in less than 1 in 100 cases of infection. This risk increases with age. The patient may die if the respiratory and swallowing muscles are affected. Those who survive may develop residual paralysis. Severe pain, and wasting are common in paralyzed muscles. Recovery can take up to a year.
The incubation period is 7-14 days. A blood test for antibodies will confirm the diagnosis, although this is not always available abroad. Patients are infectious by close contact and should be isolated for at least a week.
Treatment: The development of paralysis is clearly an emergency and medical help should be sought without delay. If the paralysis affects the breathing muscles, artificial means of respiration may be required. Extreme care should be taken when disposing of excreta for up to 6 weeks.