Typhoid fever, rare cause of hallucination

Typhoid fever is a life-threatening illness that is both
preventable and treatable with antibiotics. However,
experts warn that when the infection is not promptly
treated, it is deadly in that it can cause internal
bleeding, perforation of the intestine and
hallucination, reports Sade Oguntola.
Typhoid fever is a bacterial disease,
caused by Salmonella typhi. It is
transmitted
through the ingestion of food or
drink contaminated by the faeces or
urine of infected people. It is a
serious health threat resulting in
some 22 million new cases yearly
and approximately 217,000
fatalities.
Salmonella typhi lives only in humans. According to
Dr Adegboyega Akere, a consultant
gastroenterologist, University College Hospital (UCH),
Ibadan, Oyo State, 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
Salmonella typhi in their stool.
Dr Akere said: "Carriers are not sick; in fact their
symptoms have disappeared.
However, they still have the bacteria, Salmonella
typhi, especially in their gall bladder and other parts
of the body. The gallstones serve as reservoir for
Salmonella typhi. In addition, people that pass blood
with their urine due to Schistosomiasis (bilharzias)
also acts as reservoir for the Salmonella typhi."
Unfortunately, food handled by vendors with typhoid
fever who don't wash their hands after going to the
toilet can contaminate the food they sell with S.
Typhi if they are carriers.
"Food handlers that are chronic carriers of S. Typhi
are a special health hazard because they spread the
organism that causes typhoid fever. Although, they
are not sick, they continue to shed the bacteria,"
stated Dr Akere.
How soon do symptoms appear? Symptoms
generally appear one to three weeks after exposure.
Persons with typhoid fever usually have a sustained
fever as high as 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 or 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 Salmonella typhi.
"The body temperature increases in a step-like
fashion. Today, it is 38° tomorrow it changes to 39°
and it keeps increasing each day without subsiding
compared to what happens in malaria. In malaria, the
temperature is high and after a while reduces and
then goes up again," he explained.
With typhoid fever, Dr Akere said, "in the first few
days, aside the increasing body temperature, there is
headache and rose-coloured spots on the chest.
Then after a while, the person will start to have
abdominal pain, especially in the right lower side of
the abdomen. Later constipation and or diarrhoea
sets in. But constipation is commoner in children but
diarrhoea in adults."
Typhoid fever can be prevented and can usually be
treated with antibiotics.
However, if left untreated different complications can
develop. "Typhoid fever is a systemic disease that
affects several organs of the body, not just the
digestive organs," said Dr Akere.
He declared: "When a person eats contaminated food
or drink, including contaminated water, the
organism, Salmonella Typhi, enters through the
digestive tract and from there into the blood stream.
The germ through the blood spreads to different
body organs aside the digestive tract."
When typhoid fever is left untreated, Dr Akere stated
that complications can result when it infects any
organ in the body, including the heart, brain, kidney
and lungs. "The person may start to bleed internally
when there is perforation of a portion of the colon.
When there is perforation of the colon, its content
spills into the abdominal cavity, causing severe
infection again. This is deadly. As a result, the person
might feel pain all over the abdominal area. Of
course, the person will be very sick and might even
go into shock."
Moreover, he said that another complication of
typhoid fever was typhoid psychosis. "The person
could have what is called a psychiatry manifestation
of typhoid fever. Such a person starts to behave like
a person with psychiatric problem; such starts to
behave abnormally. The person may be extremely
aggressive, confused, disoriented and may be
hallucinating."
According to the medical expert, typhoid fever gives
different symptoms depending on the organ of the
body that it infects.
But, "typhoid fever is a treatable with antibiotics and
with these drugs, the body can get rid of this
infection on time if treatment commences early.
"Even carriers of the bacteria also need to be treated
with antibiotics, but for a longer period of time, say
about six weeks, to clear it from their body system.
However, carriers with gall stone will have to remove
their gall bladder through surgery because gall
stones serve as reservoir for the bacteria. Without
the removal of the gall bladder, the bacteria cannot
be totally eradicated from the body."
Meanwhile, Dr Akere assured that people can be
vaccinated against typhoid fever. There are both
injectable and oral vaccines for typhoid fever. The
vaccine is to be followed up with booster doses every
two to five years. But the vaccine is more suitable for
people coming from non-endemic typhoid fever
regions to endemic typhoid fever regions.
Places endemic for typhoid fever include Asia, Latin
America and Africa. So, for people coming from
countries such as United Kingdom, Canada and
United States of America, it is advisable that they
take be vaccinated.
Nonetheless, he stated that it was better for people
in typhoid fever endemic areas, including Nigeria, to
ensure they are protected from this disease that
could kill. According to him, the most important step
in protecting one's self from the disease is personal
and environmental hygiene, including proper sewage
disposal.
"The person that is sick with typhoid fever sheds the
bacteria through the faeces. If faeces is properly
handled, there is no way it will contaminate food or
water. Growing food items with human faeces or
waste water also contaminate food, thus
predisposing individuals to different diseases
including typhoid fever.
"Regular hand washing after visiting the toilet is also
important just as there is the need to be sure of the
source of water used in the preparation of food and
washing of hands," he further added.
Watching what one eats and drinks when one travels
is also as important as being vaccinated in the
prevention of typhoid fever, including travellers'
diarrhoea, cholera, dysentery, and hepatitis A.