I gave a health-talk two weeks ago, to our Men’s Christian Association (MCA), Presbyterian Church, World Bank Parish Umuahia. As part of the commemoration of our Father’s Day, which took place on June 18, 2017. Majority of the responses during question and answer, centered on fever, requisite laboratory tests, typhoid and malaria.
One member took the gauntlet and asked the one million question – “doc”, he bellowed, “please explain, why is it that ‘every time I go to the lab, it is typhoid or malaria’?” More than ten men nodded their heads vigorously and chorused ‘yes’. I shocked them with my answer. I said, “even if you do the test one thousand times, the result will still show traces of typhoid and malaria. “Heee” all of them exclaimed simultaneously. Yes I said, because we live in typhoid and malaria endemic region. They were all looking lost.
I explained further. “That is why you need a medical doctor to interpret your laboratory results. A lot of factors are taken into consideration, by the doctor that is interpreting your laboratory results. What obtains today is mind bogging. A Laboratory Scientist, after performing your test, usurps the role of a doctor, and prescribes drugs at the back of your laboratory results. I have been fighting a relentless war against them.
This is a clarion call to all of you. Please take your laboratory results to qualified doctors for interpretations and prescriptions. A doctor knows when to treat, and when not to treat typhoid and malaria. My MCA members also wanted to know the meaning of endemic disease and epidemics.
In the tropics, malaria and typhoid fever are among the common infectious diseases, with both being endemic in Nigeria.
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.
Please follow me on twitter; @_DRSUN