Typhoid fever

Definition of typhoid fever

-  An infectious bacterial fever with an eruption  of red spots on the chest and abdomen and severe intestinal irritation. 

- That causes diarrhea and a rash. 

- It is most commonly due to a type of bacterium called Salmonella typhi.

Causes

• Salmonella typhi is spread through contaminated food, drink, or water
• If you eat or drink something that is contaminated with the bacteria, the bacteria will enter the body. It travel into our intestines, and then into our blood. The bacteria travel through the blood to our lymph nodes, gallbladder, liver, spleen, and other parts of the body.

Symptoms

Early symptoms include fever, general ill feeling and abdomen pain. High fever ( 39°c ) or higher and severe diarrhea occur as the disease gets worse.

Other symptoms iclude :-

• Abdominal tenderness
• Agitation
• Chills
• Confusion
• Weakness
• Severe fatigue
• Hallucinations

Exams and Tests

~ A complete blood count ( CBC ) will show a high number of white blood cells.

~ A blood culture during the first week of the fever can shows S.typhi bacteria. 

~ ELISA urine test to look for the bacteria that causes Typhoid fever.

~ Platelet count 

~ Stool culture

Treatment

:: We can ask for drink uncontaminated water with electrolyte packets. 

:: Antibiotics are given to kill the bacteria. Health care provider will check current recommendations before choosing antibiotics.

Prevention

•  Wash our hands - wash our hands thoroughly with hot, soapy water, especially before eating or preparing food after using the toilet.
• Avoid drinking untreated water -  drink only bottled water or canned or bottled carbonated beverages, wine or beer. Use bottled water to brush our teeth, and try not to swallow water in the shower
• Choose hot foods - Avoid food that's stored or served at room temperature.
• Vaccines - one is injected in a single dose about two weeks before exposure.

                         - one is given orally in four capsules, with one capsule to be taken every other                           day.

• Avoid raw fruits and vegetables - raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel.
• Clean household items daily - clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner or disposable cloths.
• Keep personal items separate - wash towels, bed linen and utensils in hot, soapy water.

  reference : typhoid fever

• Papagrigorakis MJ, Synodinos PN, Yapijakis C. Ancient typhoid epidemic reveals possible ancestral strain of Salmonella enterica serovar Typhi. Infect Genet Evol. Jan 2007;7(1):126-7. [Medline]. [Full Text].

Using epidemiology triangle concept in order to control LEPTOSPIROSIS

AGENT

Leptospirosis is a bacterial disease that affects humans and animals. It is caused by bacteria of the genus Leptospira. In humans, it can cause a wide range of symptoms, some of which may be mistaken for other diseases. Some infected persons, however, may have no symptoms at all. Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.

MODE OF TRANSMISSION

1. Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as the urine is still moist.
2. Although leptospira has been detected in reptiles and birds, only mammals are able to transmit the bacteria to human and others animals.
3. Rats and mice are important hosts but a wide range of other mammals including dogs, deed, rabbits, hedgehogs, cows, sheep, cows, sheep, raccoons, opossums, skunk, and certain marine mammals carry and transmit the disease as secondry host.
4. House- bound domestic dogs have contracted leptospirosis, apparently from licking the urine of infected mice in the house. 
5. The type of habitats most likely to carry infective bacteria are muddy riverbanks, and muddy livestock rearing areas where there is regular passage of wild or farm mammals.
6. The incidence of leptospirosis correlates directly with the the amount of rainfall, making it seasonal in temperate climates and year-round in tropical climates.
7. Leptospiros also transmit via the semen of infected animals. Human become infected through contact with water, food, or soil that contains urine from these infected animals.
8. This may happen by swallowing contaminated food or water or through skin contact. The disease is not known to spread between humans, and bacterial dissemination in convalenscence is extremely rare in humans.
9. Leptospirosis is common among water- sport enthusiasists in specific areas, as prolonged immersion in water promotes the entry of the bacteria.

PREVENTION

• Wearing protective clothing for people at occupational risk and avoidance of swimming in water that may be contaminated.
• Leptospirosis control in animals is dependent on the serovar and animal species but may either vaccination, a testing a culling programme, rodent control or a combination off these strategies.
• The large number of serovars, variety of infection sources and the wide differences in transmission conditions, the prevention and control of leptospirosis is complex.
• Effectie prevention and control can be achived by controlling the reservoir or reducing infection in animal reservoir populations such as dogs or livestock treatment or vaccination of the animals.
• Control of wild animals may be difficult. Preventive measures must be based on knowledge of the groups at particular risk of infection.
• Prevention and control should be targeted at is a the infection source. The route of transmission between the infection source and the human host or prompt and proper treatment of infection.

SYMPTOMS 

• Leptospirosis infection in human causes a range of symptoms, and some infected persons may have no symptoms at all.
• The symptoms appear after an incubation period of 7-12 days. The first phase ( acute of septicemic phase ) end after 3-7 days of illness.
• The dissappearance of symptoms coincides with the appearance of antibodies against leptospira and the dissappearance of the bacteria from the bloodstream.
• The patient is asmptomatic for 3-4 days until the second phase begins with another episode of fever.
• The hallmark of the second phase is meningitis ( inflammation of the membranes covering the brain ).
• Symptoms caused disease leptospirosis are fever and headache persistent vomiting diarhea muscle and joint pain abdominal pain jaundice (yellow eyes ) cough, eye inflammation and rash.

HOST

PREVENTION

1. Can be reduce by reducing swimming in contaminated water.
2. Not in contact with animals that have been exposed to infection
3. Wear the PPE
4. Increasing the frequency goes wellness center.
5. Give lepto vaccine to pets although not 100% immune.
6. Pet's owner should take antibiotics as doxycyline or penniciline.
7. Do not hold the urine, the blood of animals that not have proper treatment.
8. Always wash hand with anti- bacterial celaning solution. 

MODE OF TRANSMISSION

1. Leptospirosis can effect human directly or indirectly through exposure to animal urine of the bearer.
2. The genus leptospira bacteria enter the bloodstream through wounds, skin abrasions and through mucous membranes such as eyes, nose and mouth.
3. Also spread via semen of infected animals, abattoir workers may be infected through contact with bodily fluids and direction.
4. Human can be infected through exposure of water, food or soil containing urine from infected animals bacteria.
5. May happen by swallowing contaminated food or water or by contact with the skin.
6. Dog lick urine then go near master.

ENVIRONMENT

LEPTOSPIROSIS

1. Is an emerging zoonotic disease.
2. It is an infections disease cause by pathogenic bacteria called leptospires.
3. That are transmitted directly or indirectly from animal to human.

ENVIRONMENT FACTOR

• Animal stocking density ( eg. all the animals in a place )
• Animal movement between groups.
• Housing ( eg. ventilation, sanitation )
• Environment condition ( eg temperature)
• Nutrient ( eg. protein )

CONTROL OF ENVIRONMENT

1. Sources of infection such as exposure to infect animal and potentially contaminated bodies of water.
2. It may also include environment clean-ups and draining.
3. Alert public or users regarding the hazards of possible contaminated through environment risk.
4. Health hazards signage should be posted in areas found to be contaminated through environment risk.
5. Advice public to keep their homes and premises free from rodents.
6. Advice public to vaccinate their pets.
7. Promote cleanliness at the recreational areas, food premises.
8. Reduce by not swimming which contaminated with animal urine.
9. Removal of rubbish and keeping areas clean.

WHAT ARE THE SYMPTOMS OF DISEASE?  

- The incubation period of time, namely the period of time of exposure to onset of  symptoms is between 2 to 10 days.

- This disease shows of variety of clinical symptoms. - Among the symptoms of leptospirosis infection can be shown by patients are high fever, headache, chills, muscle pain, vomitting, jaundis, jaundis, inflammation of the eyes, abdominal pain, diarrhea, cough and a rash on the skin.

- This disease can be categorized into for category based on the clinical signs in as follow ( WHO 2003)

• Influenza like illness that light.
• Weil's syndroms - jaundis, renal failure, bleeding in flammation of the heart muscle with an irregular hearts beat.
• Meningitis
• Pulmonary hemorrhage with respiratory failure.

CONFIRMATION OF LEPTOSPIROSIS IS THROUGH :

• Verification leptospira bacteria through culture of blood samples, cerebrosipinal fluid, and urine.
• Serology test to detect specific antibodies such as Microscopic Agglunation Test (MAT), test immunofluorescent techniques (IF), and ELISA.

WHETHER THE DISEASE CAN BE TREATED 

1. This disease can be treatedwith certain antibiotics.
2. For those who show symptoms as above shall hasten to the nearest clinical for examination and treatment, especially for those who have a history of exposure to contaminated water and food.
3. Early treatment with antibiotics can prevent complications and death

Doxycline antibiotics can be given as prophylaxis to those who are to infection through work (military, rescue workers and other ). However, the doctor's advice should be obtained before taking prophilaxis.

REFERENCE : LEPTOSPIROSIS

using epidemiology triangle concept in order to control LEPTOSPIROSIS

What are the symptoms of this disease?

- The incubation period of time, namely the period of time of exposure to onset of symptoms is between 2 to 10 days.
- This disease shows of variety of clinical symptoms.
- Among the symptoms of leptospirosis infection can be shown by patients are high fever, headache, chills, muscle pain, vomitting, jaundis, inflammation of the eyes, abdominal pain, diarhea, cough and a rash on the skin.

-This disease can be categorized into for category based on the clinical signs in as follow (WHO, 2003) 

• Influenza like illness that light.
• Weil's syndroms - jaundis, renal failure, bleeding in flammation of the heart muscle with an irregular heart beat.
• Meningitis
• Pulmonary hemorrhage with respiratory failure.    

Confirmation of Leptospirosis is through : 

• Verification leptospira bacteria through culture of blood samples, cerebrosipinal fluid, and urine.
• Serology test to detect specific antibodies such as Microscopic Agglutination Test ( MAT ), test immunofluorescent  techniques (IF ), and ELISA

Whether the disease can be treated?

• This disease can be treated with certain antibiotics. For those who show symptoms as above shall hasten to the nearest clinic for examination and treatment, especially for those who have a history of exposure to contaminated water and food. Early treatment with antibiotics can prevent complications and death.

Doxycyline antibiotics can be given as prophylaxis to those who are exposed to infection through work ( military, rescue workers and other ). However, the doctor's advice should be obtained before taking prophilaxis.  

REFERENCE : LEPTOSPIROSIS