> Holy Moses! “What did you say?” He repeated selfishly, varying the emphasis, “ I want you to cure my typhoid permanently “. “Bite me, did I hear you right”. That was a patient who consulted me last week, at Gregory University Uturu.
> I pressed the bell, when my secretary came in, I told her to get me the mortuary attendant. Turning to my patient, I said, “I want him to lock you up with the dead bodies, so that your typhoid will be permanently cured” The guy nearly fell off his seat, “but that’s not true doc, you cannot cure typhoid permanently by sleeping in the mortuary. “So you know that”, I glared at him, “and you are asking me to play God”.
> Do know that, if I had the privilege of Solomon in the Bible, where God Almighty will ask me to make a request of what I needed. I shall give Him a long list of diseases that should be permanently cured or eliminated. Number one in the list is 1) cancer, nobody created by God should die of cancer. Then I will add 2) Hypertension 3) diabetes 4) sickle cell disease 5) leprosy 6) tuberculosis etc etc I do not mind, if I were to remain jobless for lack of diseases to treat.
˃ I could open a body fitness enterprise and become the CEO, because I suspect that if I add obesity to the list of diseases to be eliminated, God will tell me to remove it, that obesity is man-made and self-inflicted, and therefore not a disease. That obesity results due to our greedy, ravenous, gluttonous and excessive consumption of un-needed food.
˃ After I had let off some heat I decided to re-visit, the words endemic, pandemic and epidemic as it relates to typhoid fever, and to explain why typhoid fever, which is endemic in Nigeria, cannot be permanently eliminated or “cured” as erroneously thought by my patient.
How do we define the word “endemic?
Endemic is a characteristic of a particular population, environment or region that is peculiar and intrinsic to it.
Endemic disease: is a disease that is always present in a certain population or region. Examples of endemic diseases include malaria and typhoid fever etc, these occur at a predictable rates among young school children in Africa and Nigeria.
Epidemic: this is an outbreak of disease that attacks many people at about the same time, and may spread through one or several communities.
Pandemic: this is when an epidemic spreads through out the whole world.
Define typhoid fever.
Typhoid fever is an acute illnesses associated with fever caused by Salmonella typhi bacteria. It can also be caused by salmonella para-typhi, a related bacterium that usually causes a less severe illness.
What are the signs and symptoms of typhoid fever?
Usually divided into four stages.
Stage I – 1st Week. 1) fever 2) bradycardia – low heart rate 3) malaise. 4) headache 5) cough 6) epistaxis – bleeding from the nose 7) abdominal pain 8) leukopenia – decrease in circulating white blood cells 9) note; blood cultures are positive for salmonella typhi and para-typhi in the first week, while widal test is negative.
Stage II – 2nd Week. 1) Patient with typhoid becomes too tired to get up. 2) high fever is still persistent 3) delirium becomes frequent – often calm but sometimes agitated. Delirium gives typhoid the nickname “nervous fever”. 4) Rose spots appear on the lower chest and abdomen 5) Noisy lungs – wheezing and grunting. 6) Doughy abdomen which might become distended. 7) Diarrhoea can occur. 8) Constipation is also frequent. 9) Spleen and liver are enlarged. 10) Widal test becomes positive from the second week.
Stage III – 3rd Week 1) Mostly week of complications – intestinal haemorrhage. 2) Intestinal perforation in the distal ileum – this is a very serious complication, and must be treated immediately or it will lead to septicaemia and peritonitis. 3) Encephalitis could occur. 4) Respiratory distress in form of pneumonia and acute bronchitis could occur. 5) Neuro-psychiatric symptoms could develop. 6) Metastatic abscesses leading to cholecystitis(inflammation of gall bladder), endocarditis and osteitis(inflammation of the bone) could develop.
Stage IV – 4th Week.
Fever subsidies, and if there are no complications, patient starts recovering.
How do we diagnose typhoid fever?
We use blood, bone marrow and stool. 1) First week – blood culture is positive, while widal test is negative. 2) Second week – blood culture, widal test and stool culture are all positive.
How do we treat typhoid fever?
Please consult your doctor. Avoid self medication.
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