Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is still common in the developing world, where it affects about 12.5 million persons each year. Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning traveling to endemic area, you should know about typhoid fever and what steps you can take to protect yourself.

How do you got TYPHOID FEVER ?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool).

You can get typhoid fever if you eat food or drink beverages that have been handled 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.

Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

What are the signs and symptoms of TYPHOID FEVER?

Persons with typhoid fever usually have a sustained fever as high as 103° to 104° F (39° to 40° C). They may also feel weak, or have stomach pains, headache, or loss of appetite. In some cases, patients have a 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 or blood tested for the presence of S. Typhi.

What do you do if you think you have TYPHOID FEVER?

If you suspect you have typhoid fever, see a doctor immediately. If you are traveling in a foreign country, you can usually call the U.S. consulate for a list of recommended doctors. You will probably be given an antibiotic to treat the disease. There commonly prescribed antibiotics are CHLORAMPHENICOL, THIAMPHENICOL, CIPROFLOXACIN, and PEFLOXACIN.

Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, persons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection.

How can you avoid TYPHOID FEVER?

Two basic actions can protect you from typhoid fever:

1.  Avoid risky foods and drinks.

2.  Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is 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’ diarrhea, cholera, dysentery, and hepatitis A.

“BOIL it, COOK it, PEEL it, or FORGET it”

• You drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than un-carbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings
• Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors

Getting VACCINATED

If you are traveling to a country where typhoid is common, you should consider being vaccinated against Typhoid. Visit a doctor or travel clinic to discuss your vaccination options. Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever.  They only help treat it.

What is DENGUE HEMORRHAGIC FEVER (DHF)?

DHF is a more severe form of dengue. It can be fatal if unrecognized and not properly treated. DHF is caused by infection with the same viruses that cause dengue. With good medical management, mortality due to DHF can be less than 1%.

How are DENGUE HEMORRHAGIC FEVER (DHF) spread?

Dengue Fever is transmitted to people by the bite of an Aedes aegypti mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has DHF and after about a week can transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person.

What are the symptoms of the disease?

The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults.

Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding.

The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.

Is there an effective treatment for DENGUE HEMORRHAGIC FEVER (DHF)?

As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF.

How can we prevent epidemics of DENGUE HEMORRHAGIC FEVER (DHF)?

The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides and adulticides).

Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of sites where mosquitoes can be produced.

What is travelers’ diarrhea?

Travelers from temperate regions of the world frequently experience diarrhea four days to two weeks after arriving in certain areas of the world. This illness is called travelers’ diarrhea. Other colorful and humorous terms used to describe this illness include “Montezuma’s Revenge, the “Delhi Belly” in India, the “Bali Belly” in Bali and the “Hong Kong Dog” in the Far East.

How common is travelers’ diarrhea?

Twenty to 50% of travelers may develop diarrhea depending on the region of the world they visit. Diarrhea is the most common illness of travelers. In general, travelers at risk for diarrhea commonly come from industrialized nations and travel to high-risk areas that are primarily within developing or less industrialized nations of the world, including Latin America, Africa, the Middle East, and Asia. Areas of lesser risk include China and some Caribbean nations. Travel to areas of the United States, Canada, Northern Europe, and Australia pose the lowest risk to travelers.

Men and women are at equal risk for developing travelers’ diarrhea. Younger individuals are more commonly afflicted, perhaps because of more adventurous eating habits. People with disorders that compromise their immune system (such as HIV, cancer, chemotherapy, steroid use), diabetics and people with underlying abdominal disorders (irritable bowel syndrome, colitis) are more susceptible to travelers’ diarrhea. Interestingly, people on acid blockers for their stomachs (like famotidine, cimetidine, omeprazole, esomeprazole) also have a higher susceptibility to travelers’ diarrhea because they have less stomach acid to protect them from the bacteria that cause the condition

What causes travelers’ diarrhea?

Travelers’ diarrhea usually is contracted by the ingestion of contaminated food or water. Contrary to common belief, food - not water - is primarily at fault. Most cases of travelers’ diarrhea are caused by bacteria. The most important bacterium is enterotoxigenic E.coli which is estimated to account for up to 70% of all cases.

Other bacterial species implicated in travelers’ diarrhea include Campylobacter jejuni, Shigella, and Salmonella. Viruses (including Rotavirus, Norwalk Virus and other enteric viruses) less commonly are causes of travelers’ diarrhea.

Parasitic infections are an uncommon cause with the exception of Giardia Lambia, which should be suspected in individuals traveling to Russia or to mountainous regions of the Northern Hemisphere. Cryptosporidia, another parasite, also has been implicated as a common cause of diarrhea in visitors to St. Petersburg, Russia.

What are the symptoms of travelers’ diarrhea?

The symptoms of travelers’ diarrhea vary. Generally, diarrhea occurs within the first week of travel and lasts up to three to four days. Affected individuals on average pass up to five loose or watery bowel movements per day which may be associated with cramps. On occasion, individuals may experience fever or bloody stools.

How to treated travelers’ diarrhea?

Although prophylactic antibiotics are effective in preventing travelers’ diarrhea, they generally are not recommended. The side effects of antibiotics, including photosensitivity and diarrhea can be major problems. Antibiotic prophylaxis can be considered in individuals with underlying medical diseases in whom diarrhea is more likely to occur or who may be profoundly affected by the diarrhea. This group includes people with previous stomach surgery, active inflammatory bowel disease, underlying immunodeficiency conditions, and other serious medical disorders. In these situations drugs of the quinolone class ciprofloxacin, levofloxacin have been shown to be effective.

When treating afflicted individuals, drugs that alleviate symptoms as well as antibiotics play a role. With moderate symptoms, the addition of Pepto-Bismol alone may suffice. Alternatively, anti-diarrheal agents such as diphenoxylate and atropine or loperamide can be given.

With severe disease, characterized by frequent diarrhea or dehydration, or complicated by the passage of bloody stools, diphenoxylate and atropine or loperamide should not be used and you should consult your doctor. Oral fluids are a mainstay of therapy since they are important to prevent dehydration.

Tips for staying hydrated are:

Children and the elderly are more susceptible to dehydration. If you feel light-headed or woozy, feel a rapid pulse or your mouth and lips are dry you should consult a physician. If a child is listless, not eating or drinking and does not make wet diapers or urinate within a few hours they also should be seen by a doctor

How can to prevent travelers’ diarrhea?

Since food is the mayor source of infection, close attention to diet is of foremost importance in the prevention of travelers’ diarrhea. Foods should be well-cooked and served warm. Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided. Dairy products, tap water and ice (including frozen drinks not made from filtered water) are also high-risk foods. Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled and canned products generally are safe. The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors. Also, frequent hand washing with soap and clean water will decrease the likelihood of the bacteria’s spread.

Travelers’ Diarrhea

• Travelers’ diarrhea is a gastrointestinal illness that occurs in travelers.
• Travelers’ diarrhea usually is caused by eating food contaminated with bacteria or, less commonly, with parasites or viruses.
• Travelers’ diarrhea usually is mild and self-limited to a few days or a week.
• The treatment of travelers’ diarrhea is usually plenty of oral liquids as well as over-the-counter medications that control diarrhea and cramps.
• Antibiotic prophylaxis (prevention) for travelers’ diarrhea is available but is not recommended generally.

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