Typhoid is a disease caused by a bacterium known as Salmonella Typhimurium, S. Typhi. Typhoid has many symptoms but is mainly characterized by a fever that is severe and which is marked by a high temperature. Salmonella enterica serovars are types of salmonella. The illness is caused by a variety of bacteria species, including Typhi. Other strains, such as Paratyphi A, Paratyphi B, and Paratyphi C, may be classed as typhoid salmonella, a kind of Salmonella. The bacterium strains live in the host’s intestines and bloodstream. The bacteria is transmitted only from humans to humans since animals do not carry the disease. Typhoidal Salmonella is spread mostly via contaminated water or food that has been contaminated with human feces. In developing nations, the danger of illness is high, with typhoid Salmonella being common, insufficient hygiene and sanitation, and a lack of safe drinking water and sanitation facilities all contributing to the problem.
If the illness is left untreated, it may cause more severe gastrointestinal bleeding, bowel perforation, and death. Among five cases, one person dies if left untreated. Measures such as improving sanitation have seen typhoid infections go down, but the rates of infections are still high. The high infection rates have been due to poor education to travelers to take a vaccine, poor diagnosis of the bacterium causing typhoid, and drug resistance. Very little is known about typhoid disease, and only little is studied due to the early treatment of patients due to patient safety.
Epidemiology
As the global assessment shows, approximately 27 million new typhoid cases occur each year, with a death rate of around 200,000. Southern Central and Southeast Asia are the most remarkable diseases and mortality (WHO,2019). A planned population-based recognition of five Asian countries, including Pakistan, revealed that Pakistan has the second most remarkable frequency of typhoid illness at the estimated annual incidence of 412.9 per 100,000 people. In 2010, the International Vaccine Institute assessed 11.9 million typhoid fever and 129 000 low-and-center wage countries.
In low-and-center wage countries with endemic typhoid Salmonella and poor sanitation, and inaccessibility to clean supplies and water, the risk is significant in the research carried out in the countryside of Islamabad, Pakistan. The major way of spreading is sullying with human feces, and a common vehicle is contaminated water, nutrition, organic crude goods, vegetables, sweets, and touch with or with infectious patients. Explorers, children, old persons, and invulnerable individuals trafficked are especially at risk. Children between 2-10 years and young people up to 25 years old, irrespective of their genders, are subject to the adverse effects of enteric fever and are admitted to healing centers in endemic areas, as is commonly found in the research conducted in countries where typhoid is most prevalent and where typhoid prevailed at a younger age. In addition, environmental variables like precipitation, vapor weight, and temperature significantly impact the transmission and circulation of typhoid illnesses in humans. In summer, the prevalence of typhoid fever is greater.
Bacteriology
The intracellular disease responsible for typhoid in humans is Salmonella Enteric Serovar Typhi (S. Typhi). The organism is a flagella, non-sporulated, anaerobic gram negative bacillus, non-capsulated and antigenic exterior coat. Serologically, the bacteria is positive for O9 and O12, flagellate Hd protein, and capsular Polysaccharide antigen.
Symptoms and signs
The typhoid-causing bacterium enters the body of a human being through the mouth. Ingestion of Salmonella may cause symptoms to appear anywhere between 7 and 14 days after ingesting the bacteria. Fever is the most common symptom during this period. The temperature is rising, and the following week may see highs of 39 to 40 degrees Celsius. Fever and rashes are two of the most common symptoms (Crump, 2019). Typhoid fever is very severe, and it may reach temperatures of 104 degrees Celsius or 39 to 40 degrees Celsius over many days. The rash associated with typhoid is characterized by pink patches that appear on the neck and abdomen in particular, although not all patients get the rashes. Some additional symptoms to look out for include malaise, abdominal headache, constipation, and other constitutional signs. Constipation is a common early symptom, but many individuals also have diarrhea at some point. Increased temperature, relative bradycardia, splenomegaly, hepatomegaly, abdominal sensitivity, and meningitis are some of the physical manifestations of the disease. Bowel bleeding, myocarditis, gut perforation, thrombophlebitis, urinary retention, cholecystitis, pneumonia, osteomyelitis, nephritis, meningitis, and myocarditis are the most serious effects among patients spectrum of the disease or those who seek treatment after prolonged infection. Some people, however, are carriers of typhoid and hence suffer no effects but can spread to others.
Diagnosis
In the United States, the World Health Organization (WHO) predicts that about 21 million instances of typhoid fever are likely to be missed because of poor diagnosis each year, according to the WHO (WHO,2019). A few diagnostic methods are available, including clinical symptoms and adverse effects, serological indicators, bacterial culture, antigen identification, and DNA intensification.
Treatment
Typhoid is a bacteria that cause disease, is treated using antibiotics. Pregnant women take ceftriaxone, while those who are not pregnant take ciproflaxine. One should take a lot of water and avoid dehydration.
In the realm of creation, typhoid fever is a significant public health issue to be concerned about. Recent developments in the last two decades have seen the emergence and outspan of multidrug resistance in typhoid salmonella, particularly in South and Southeast Asia, including Pakistan. Chloramphenicol, co-trimoxazole, and ampicillin have been the antibiotics used since some decades ago, but the drugs may be resistant in some people. Azithromycin is used to treat typhoid fever and may be used as an alternative to fluoroquinolone therapy in regions where fluoroquinolones are often banned and resistant.
Prevention
It is preventable through observing hygiene, e.g., taking bottled water or boiled water, washing and peeling fruits, not eating street food, and not having ice added in drinks, especially when in places with typhoid history and vaccination for travelers. The vaccine is taken two weeks before travel. However, people who are currently ill or HIV positive should not take the vaccine.
Since early recognition in the transmission of typhoid fever, enhancements in access to clean water and improved sanitation have shown significant reductions in the rite of passage associated with typhoid disease in many environments. In addition, the global network has declared that clean drinking water and sanitation are human rights problems because of their importance in the well-being of humans. Unmistakably, since clean water and improved sanitary services are being created, the entrance into nature of S. Typhi and S. Paratyphi bacteria and thus entry fever disease is severely reduced (Radhakrishnan et al.,2018). However, global progress towards widespread access to safe water, as well as to improved sanitation at the family level, where ideal medical benefits are lacking and probably exacerbated by several variables which incorporate disparities in scope, where the underprivileged access to the most defenseless population is the most vulnerable; increasing urbanization and expanding water shortages in numerous districts.
While there has been considerable interest in typhoid fiber vaccine for some time, and while control responses to typhoid have made significant progress, this progress has been considerably slowed in many areas due to budget constraints. The main antibody, an inactivated full cell immunization, has been used in British and American military populations for more than a century, but it was previously deemed too reactogenic to be used in civilian populations. Two typhoid contradictions are now usually allowed and seem protective and adequate for people older than two years old. The first is an oral antibody derived from the S. Typhi Ty21a strain that has been attenuated in live animals.
Individuals above the age of 2 years may be tested with a single dose of the Vi-Capsular Polysaccharide (Vi-PS) antibody, manufactured by specific manufacturers and pre-qualified for use by the World Health Organization (WHO).
Conclusion
Typhoid fever, triggered by gram-negative bacteria Salmonella enteric serval Typhi, is most common in the Asian region, particularly in the emerging Asian nations like Pakistan and India. It is a contagious illness orally transmitted caused by the consumption of contaminated food and drink. The disease’s incubation time is one to two weeks. Symptoms include high fever, lethargy, rash, constipation of stomach discomfort, chronic headache, and low appetite. The treatment of antibiotic resistance is a significant issue. Firstline medicines are mostly not utilized to treat typhoid, and fluoroquinolones have resistance. Ceftriaxone and azithromycin are the only medication left. The counteractive effect of typhoid fever is mainly via personal and domestic hygiene. A clean water supply and proper human wastes disposal eliminate S. Typhi. Good monitoring, improved diagnosis, more sensitive use of medicines, and effective vaccination will decrease the burden of S. Typhi illness.
