Health Wise

How is typhoid fever spread?

Salmonella Typhi lives only in humans. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of people, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella 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 Salmonella Typhi or if sewage contaminated with Salmonella 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 Salmonella Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

Typhoid is one of the most commonly prevalent food and water borne diseases in south Asia, including Sri Lanka. Once upon a time it was a disease to be feared. Not today thanks to medical intervention and awareness raising.

However, the fact that we still have between 1,500 to 2,000 patients being treated in hospitals because of it, has prompted health authorities to reiterate the need for personal hygiene to prevent this bacterial disease transmitted via the foeco-oral route.

Consultant Epidemiologist Dr Manori Malawarachchi of the Epidemiology Unit, Health Ministry, explains what the disease is, and outlines the golden rules that can prevent it.

Answer: Typhoid is caused by Salmonella typhi. It is a bacterial diarrhoeal disease. It is transmitted through foecal matter that is ingested i.e. the foeco-oral route.

A: Flies or insects that have had contact with foecal matter can infect unprotected food. A person who ingests this food can then get the disease. Or else, a food handler with the disease, who does not wash his hands properly after using the toilet, can also infect the people for whom he prepares and serves food.

Q: What kind of symptoms does one have to watch for in a suspected case of typhoid?

A: In the first week a patient may have a persistent headache, malaise (fatigue) and a cough. In the second week he can experience high fever as the fever will begin to rise slowly during the first week to over 38 degrees C to upto 40 degrees c. He may also experience a condition called Bradycardia (slow heart rate) and rose coloured non-itchy spots may appear on his abdomen in some patients. Other complications include septocaemia (blood poison through germs entering the blood stream) and peritonitis from perforation of the intestines. Also very rarely encephalitis affecting the brain and dehydration from water depletion.

How can you avoid typhoid fever?

Two basic actions can protect you from typhoid fever:

* Avoid risky food and drinks.
* 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 food will also help protect you from other illnesses, including travellers’ diarrhoea, cholera, dysentery and hepatitis A.

A: No. Today because many patients immediately seek medical help and get antibiotics, we rarely see these symptoms.

A: They can end up with several complications. One of the main complications is intestinal haemorrhage (bleeding from the intestines) which results in stained stools. This can be serious, because it can result in intestinal perforation. But fortunately these complications are prevented with antibiotics.

A: There is a range of such antibiotics. So if a patient is allergic to one antibiotic he/she can be given another. All of them are available free of charge at any government hospital.

A: Almost all leading private hospitals have these antibiotics, though they have to be purchased unlike in government hospitals. Different forms of Typhoid

A: Typhoid and para typhoid are collectively called enteric fever. You also get Shigella Dysentry or bacilary dystentery.

The latter is another of the various forms of typhoid and usually presents as blood mucuous diarrhoea. It is caused by the shigella bacteria from a patient's stool. There is also amoebic dysentery caused by an amoeba.

Q: Can touching faeces transmit the disease? Or sitting in the same toilet used by a typhoid patient?

A: No. You have to have to ingest it because it is passed through the alimentary canal.

Prevention

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-coloured spots. They may also get diarrhoea or constipation.

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 Salmonella Typhi.

A. Our Unit does not treat typhoid patients. If we get a notification regarding a case from a hospital or clinic, we give technical advice to the Regional Director of Health in that area. He in turn will inform the MOH's under him who will send out a team of PHI's to investigate the case. Even if a patient has no diagnosis card, the PHI's will carry out preventive measures going by the case definition to confirm the disease. If confirmed they will also try to find the source of contamination and do other preventive action.

Q: Once a person gets typhoid, it has been said that there are instances when he can still have the bacteria in his body without showing symptoms? Is that correct?

A: Yes. Such people are called asymptomatic carriers. Although they carry the germ in their bodies, they are clincally well.

A: Yes. They can shed the virus in their urine or faeces. If they are handling food they can infect others when preparing the food or serving it if they don't wash their hands properly after going to the toilet.

Q: Since food handlers are so much at risk of spreading the disease, is there anything you can give them to prevent or minimise the risk?

A: We have a vaccine for them which is not given routinely as we have limited stocks.

They are available for needy food handlers free at our government hospitals. But since it is now mandatory for food handlers to undergo these tests, the bigger hotels can obtain the vaccine from private hospitals at a fee.

A: Usually most hospitals do the Salmonella Aglutination test where the blood is tested right at the beginning, and about a week or two weeks later again to see the rising titre. Unfortunately many hospitals do just the first test, and if the titre is high it is diagnosed as typhoid.

This happens not only in provincial hospitals but some hospitals in urban areas. So the diagnosis is mainly a clinical diagnosis.

Q: The number of typhoid cases has come down to a new low at present in Sri Lanka. Your comments?

A: Yes. We have been seeing a decline in the number of typhoid cases for the past 10 years with the exception of two years – 2007 and 2009.

A: The best way to prevent typhoid is to practise good personal hygiene. Washing one's hands well with carbolic soap or a hand disinfectant can go a long way to kill the virus.

Boil it, cook it, peel it, or forget it

* If you drink water, buy it bottled or bring it to a rolling boil for one minute before you drink it.

Bottled carbonated water is safer than uncarbonated 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 food 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 travellers get sick from food bought from street vendors.

Awareness program on healthy living

Quantum Fitness will launch an awareness program on healthy living in collaboration with Sigrid de Silva, a renowned dietitian, nutrition consultant, lifestyle and wellness expert in Sri Lanka and Senaka Sylvester, a certified personal trainer. The first session/presentation will be held on September 5 at the Quantum Head office at Union Place, Colombo 2.

The presentation, Quantum Lifestyle Awareness will focus on delivering health tips while educating participants on how to live a healthy life. Designed to suit all people, young and old alike, the program will be conducted by Sigrid de Silva and Senaka Sylvester and will include elaborate explanations.

Ms. de Silva will address topics such as eating habits, lifestyle, stress factors and also exercise while Sylvester, a fitness instructor will deliver guidelines on exercise and physical work out.

“Through my many years of experience I find that the most common mistakes that people make and problems they have and some are preventable,” said Sigrid de Silva elaborating on the program. “I will be addressing all those issues. And as to why I chose Quantum was because it’s not all about the diet or just the exercise. It’s a combination of everything. Therefore, that is why when Quantum approached me I made a conscious choice of participating in this program. We really want to look after people and it is in the best interests of the individual.” According to studies obesity and overweight are becoming prevalent issues in Sri Lanka.

As these factors lead to heart diseases and diabetes, many people who suffer from these ailments are becoming more common as well.

Eating habits and proper exercise along with healthy lifestyle habits will help to combat and overcome these fitness issues.

Newly identified personality trait holds clues to why haters have to hate

New research has uncovered the reason why some people seem to dislike everything while others seem to like everything.

Apparently, it's all part of our individual personality - a dimension that researchers have coined “dispositional attitude.”

People with a positive dispositional attitude have a strong tendency to like things, whereas people with a negative dispositional attitude have a strong tendency to dislike things, according to research published in the Journal of Personality and Social Psychology. The journal article, “Attitudes without objects: Evidence for a dispositional attitude, its measurement, and its consequences,” was written by Justin Hepler, and Dolores Albarracín, Professor of Psychology at Penn.

“The dispositional attitude construct represents a new perspective in which attitudes are not simply a function of the properties of the stimuli under consideration, but are also a function of the properties of the evaluator,” wrote the authors. “[For example], at first glance, it may not seem useful to know someone's feelings about architecture when assessing their feelings about health care. After all, health care and architecture are independent stimuli with unique sets of properties, so attitudes toward these objects should also be independent.”

However, they note, there is still one critical factor that an individual's attitudes will have in common: the individual who formed the attitudes.

“Some people may simply be more prone to focusing on positive features and others on negative features,” Hepler said.

To discover whether people differ in the tendency to like or dislike things, Hepler and Albarracín created a scale that requires people to report their attitudes toward a wide variety of unrelated stimuli, such as architecture, cold showers, politics, and soccer. Upon knowing how much people (dis)like these specific things, the responses were then averaged together to calculate their dispositional attitude (i.e., to calculate how much they tend to like or dislike things in general). The theory is that if individuals differ in the general tendency to like versus dislike objects, attitudes toward independent objects may actually be related. Throughout the studies the researchers found that people with generally positive dispositional attitudes are more open than people with generally negative dispositional attitudes.

- sciencedaily

Structural skin cell defects can lead to allergies

In a new study published in Nature Genetics , Northwestern Medicine and Tel Aviv University scientists have found that a structural defect in skin cells can contribute to allergy development, including skin and food allergies, traditionally thought primarily to be a dysfunction of the immune system.

The finding is related to the team's identification of a new rare genetic disease, called “severe dermatitis, multiple allergies, and metabolic wasting,” or SAM, caused by mutations in the molecule desmoglein 1.

“Desmoglein 1 is best understood as the ‘glue’ that holds the outer layer of human skin together,” said Kathleen Green, Joseph L. Mayberry, Sr., Professors of Pathology and Toxicology. “Historically, the molecule was mainly believed to have a structural role: this adhesion between cells contributes to the physical barrier that regulates water loss and also acts as the body's major defense against environmental elements. But there are a large number of molecules that form this barrier, distributed in a highly-patterned manner, prompting our team to hypothesise that they do more than just mediate adhesion.”

Green's group at Northwestern worked with an international team that analysed clinical data from two families, combined with genetic analysis including next-generation DNA sequencing and light and electron microscopy, among other techniques. They found that when desmoglein 1 does not properly function or does not exist, the resulting barrier disruption can affect the immune response, and consequences can be severe.

“This work is also significant because it suggests that in addition to impairing the physical barrier, loss of desmoglein 1 may more directly regulate expression of genes that control the immune response and contribute to allergy,” says Green. “Conceptually, it allows us to build on previous studies and make conclusions about the importance of other structural proteins in the skin barrier.”

Green notes that the finding, combined with recent published data, could eventually lead investigators to discover further connections between defects in structural molecules and less severe allergies such as atopic dermatitis, eczema and more common food allergies.

Good hygiene can prevent typhoid

Prevention

Awareness program on healthy living

Newly identified personality trait holds clues to why haters have to hate

- sciencedaily

Structural skin cell defects can lead to allergies

- Medicalxpress