What Is Typhus?

Typhus Fever ( Typhoid ) is a disease that occurs due to infection of Salmonella Typhi Bacteria and generally spread through contaminated food and drink. Diseases that occur in developing countries and experienced by these children can be life-threatening if not handled properly and quickly. Typhus can be transmitted quickly. Typhoid fever infection occurs when a person consumes a food or drink that has been contaminated with a small amount of fecal matter containing bacteria. In rare cases, transmission occurs due to exposure to bacterial infected urine.

Main Symptoms: High Fever 
Typhus symptoms generally begin appearing 1-3 weeks after the body is infected, with the following characteristics:
  • High fever
  • Diarrhea or constipation
  • Headache
  • Stomach ache
This condition may worsen in a few weeks. If not treated promptly, there can be complications such as internal bleeding or rupture of the digestive system (gut). The risk of complications will also develop into life-threatening if the situation is not addressed immediately.

Home or Hospital Treatment?
If not treated properly, an estimated 1 in 5 people will die of typhoid. While those who remain alive are at risk of suffering from infectious complications.

Typhus is typically treated with antibiotics. The decision of treatment at home or in hospital depends on the severity experienced. If typhoid is diagnosed at an early stage, you can undergo home treatment with antiobiotic treatment for 1-2 weeks.

Hospital care is required if the late typhoid is diagnosed or already in an advanced stage.

Typhoid Vaccination
In Indonesia, typhoid vaccine as a typhoid prevention into immunization is recommended by the government, but not yet entered into the mandatory category. Typhoid vaccines are given to children over two years old and repeated every three years. Typhoid immunization in Indonesia is done in the form of syringes in infants and in oral form in children over the age of six years.

As with other vaccines, typhoid vaccine does not provide 100 percent protection. Children who have been immunized typhoid can still be infected, but the rate of infection experienced by a vaccinated child will not be as heavy as those who have not been vaccinated at all.

Vaccination is also recommended for people who intend to work or travel to areas that are being hit by cases of typhus spread. Another precaution that also needs to be done is to pay attention to food and drink to be consumed.

If you and your child intend to eat outdoors, should avoid eating in the open are easily exposed to bacteria and are advised to consume beverages in packaging.

Typhus Symptoms

In general, the incubation period of typhoid bacteria (tipes) is 7-14 days, but can also be shorter, ie three days, or even 30 days. This is the duration between the first bacteria entering the tissues of the body until the first symptoms appear.

If left untreated, the condition of typhus may worsen within a few weeks. It even takes up to months before the body can fully recover plus the increased risk of developing complications. Symptoms can also reappear because of no treatment.

Whereas if treated properly, the condition of people can begin to improve in 3-5 days. The following common symptoms occur once you get infected:
  • A fever can increase gradually every day in the first week. Fever usually rises at night
  • Muscles hurt
  • Headache
  • Feeling sick or unwell
  • Enlarged kidneys and liver
  • Fatigue and weakness
  • Sweating
  • Dry cough
  • Weight loss
  • Stomach ache
  • Loss of appetite
  • Children often experience diarrhea , while adults tend to experience constipation
  • Rashes appear on the skin of small pink spots
  • Dazed. Feeling not knowing where he was and what was going on around him
Typhus symptoms develop from week to week, with the following characteristics:

The first week
The early symptoms here need to be considered, especially related to the development of patient's body temperature.
  • Fever. Initially not high, then increased to 39 ° C-40 ° C. Body temperatures can rise or fall in this week
  • Headache
  • Limp and not feeling well
  • Dry cough
  • Nosebleed
Second week
If not handled immediately, you will enter the second stage with symptoms:
  • Higher fever that still continues to worsen in the abdominal area and chest
  • Delirious
  • Stomach ache
  • Diarrhea or severe constipation
  • Feces are generally greenish
  • Abdomen is very bloated due to swelling of the liver and bile.
The third week
The body temperature will decrease at the end of the third week, but if not treated promptly, complications may arise at this stage, such as:
  • Intestinal bleeding
  • Rupture of the intestine
The fourth week:
The temperature of the fever will decrease slowly

If not treated immediately, then there will appear other symptoms, such as delirious and lying fatigue with no movement with half-closed eyes, to life-threatening complications. In some cases, symptoms can re-appear two weeks after the fever subsides.

Immediately consult your doctor if you or your child has a high fever and some of the above symptoms. Remember that despite receiving a vaccine or immunization , someone is still likely to have typhus. Examination should also be done if you have a fever after visiting a place that has a case of typhus spread.

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Causes Of Typhus
Typhoid-causing bacteria (tipes), Salmonella typhi , enter the intestine through contaminated food or drink to then breed in the gastrointestinal tract. High fever , abdominal pain , constipation, or diarrhea will arise when these bacteria have multiplied. These bacteria are related, but not the same as the salmonella bacteria that cause a person to be food poisoning .

Bad Sanitation is a major cause of transmission
Feces that contain the bacteria Salmonella typhi is the main source of transmission of typhus. These feces are produced by people who have been infected earlier. In a country like Indonesia, the spread of Salmonella typhi bacteria usually occurs through the consumption of water contaminated with infected feces.

The same impact occurs on foods that are washed with contaminated water. This condition is mainly due to poor sanitation and access to clean water.

These bacteria can also spread if people who have been infected with bacteria do not wash their hands before touching or processing food. The spread of bacteria occurs when there are others who eat food touched by the hand of the person.

People who eat processed foods will also be infected if the processor does not wash his hands after urination because transmission can also occur from urine with bacteria, although this way is more rare.

Some of the following situations can also be the cause of the spread of typhoid:
  • Eating seafood from water contaminated with urine and feces infected
  • Eating seafood from contaminated water urine and feces infected
  • Eating vegetables using fertilizer consisting of infected human waste
  • Eating dairy products that have been contaminated
  • Using toilets that are contaminated with bacteria. You will become infected if you touch your mouth before washing your hands after taking a bowel movement.
  • Conduct oral sex with carriers of Salmonella typhi bacteria .
If not treated promptly, Salmonella typhi will spread throughout the body by entering the blood vessels. Typhus symptoms will worsen if bacteria have spread beyond the digestive system. In addition, spreading bacteria can damage organs and tissues and cause serious complications. The most common conditions occur are internal bleeding or leaking bowel.

Typhus Diagnosis

In Indonesia, Widal examination (serology test to detect the presence of salmonella bacteria) is still widely performed to determine the diagnosis. However, the interpretation of Widal's test results should be careful. This is because in endemic areas, like in Indonesia, everyone has been exposed to Salmonella thyphosa . Naturally, the body has formed antibodies against these bacteria. That is why, when the Widal examination is done, the antibodies in the body will give a positive reaction. But this does not mean you are positive for typhus. However, this test is particularly helpful in areas that do not have more sophisticated and expensive diagnostic tests.

In addition to the Widal test, there is also a faster and more accurate test for detecting typhoid, the TUBEX test. This immunological test is performed using colored particles to increase sensitivity.

Typhus is also diagnosed by analyzing blood, stool, or urine samples in the laboratory. In addition to these tests, the accuracy of the diagnosis can also be done by examining spinal fluid samples. However, this test is only used if other checks do not produce convincing results. The long time and the pain caused this test is less frequent.

If you are positive for typhoid, it's good to check with other family members to detect the possibility of transmission.

Typhus Treatment

Antibiotic therapy is the most effective way of treating typhoid and should be given as soon as possible. Your blood, stool, and urine samples will be examined in the laboratory to determine the exact type of antibiotic to administer. In addition, fever-lowering drugs can also be given to lower body temperature. Typhoid treatment (tipes) can be done at the hospital, but if more quickly detected and symptoms are still mild, you can undergo home treatment.

Typhoid Treatment (Tipes) at the Hospital
Antibiotics in the hospital will be given in the form of injections. If necessary, fluid intake and nutrients will also be inserted into the blood vessels via an IV. You may have to follow antibiotic treatment until the test result on stool and urine is completely clean from the bacteria that cause typhoid.

Infusion is given because typhoid treatments performed in hospital are generally accompanied by continuous vomiting, severe diarrhea , and flatulence . A fluid filled infusion is given to prevent dehydration due to diarrhea symptoms. Patients with children with typhoid fever may be recommended for hospitalization as a precaution.

In a few cases, surgery may be necessary in case of life-threatening complications, such as internal bleeding or damage to the digestive system.

Almost all the condition of the patient gradually improved after being hospitalized for 3-5 days. The body will recover slowly even after weeks of post-infection until you are fully restored.

Typhoid Treatment (Tipes) at Home
Generally people diagnosed with typhoid in the early stages need 1-2 weeks of treatment with prescribed antibiotic tablets. Although the body will begin to improve after 2-3 days of taking antibiotics, you should not stop consumption before the antibiotic runs out. This is important to ensure that bacteria are completely lost from the body.

However, antibiotics to treat typhoid begin to cause problems in Southeast Asian countries. Some Salmonella typhi groups become resistant to antibiotics. In recent years, these bacteria have also become resistant to chloramphenicol, ampicillin and trimotheprim-silfamethoxazole antibiotics .

Immediately consult your doctor if your condition worsens while undergoing home treatment. In a small number of people, the disease may recur again. In order for the body to recover quickly and prevent the risk of typhoid coming again, make sure you follow these simple steps:
  • Get enough rest
  • Eat regularly. You can eat as often as possible in small amounts than if you eat three large meals a day
  • Drink lots of water
  • Wash hands regularly with soap and warm water to reduce the risk of spreading the infection
Bacteria Staying in the Body

Some people who have recovered have no symptoms of typhoid, but they can still have Salmonella typhi bacteria in their intestinal tract for years. Approximately 5 percent of people with typhoid who do not undergo adequate treatment but then recover, will continue to carry this bacteria in the body. Without their awareness, these carriers can make others infected through their stools.

Generally these people can also get back to work or school. But some professions need special attention. They are advised to ensure that the body no longer has Salmonella typhi bacteria before returning to daily activities. This risky profession, among others:
  • People whose work is related to food processing and preparation
  • Nurses who often face or care for people who are vulnerable to illness
  • Elderly caregiver or elderly nurse
Additional Treatment When Typhus (Tipes) Relapse
Some people experience typhoid symptoms that recur a week after antibiotic treatment is completed. Usually the doctor will re-prescribe antibiotics despite the symptoms that are felt not as severe as before.

If after undergoing treatment the results of stool tests found that you still suffer from Salmonella typhi bacteria , you may be advised to undergo 28 days of antibiotic treatment back to clean up the remnants of bacteria. This is to reduce your potential to be a long-term carrier of Typhus bacteria.

As long as you are still diagnosed as infected, you should avoid food-processing activities. Also make sure you wash your hands after a bowel movement.

Typhoid Complications
Approximately 10 percent of people with typhoid (typhoid) suffer complications. Complications occur when people with typhoid are late or not treated with the right antibiotics. Complications occur on average three weeks after infection. The most common complication is a digestive system that experiences internal bleeding and infection that spreads to the surrounding tissues to cause the bowel or digestive system to rupture.

Symptoms of Internal Bleeding
Typhus people who experience deep bleeding usually feel the symptoms such as feeling tired all the time, shortness of breath, vomiting blood, pale skin, irregular heartbeat, and black stools.

Generally bleeding in the effects of typhoid is not life threatening. However, blood transfusions may be needed to replace blood loss from the body. Surgery may also be needed to repair damage to the bleeding area.

Injury to the Wall of the Digestive System
Perforation occurs when the wall of the digestive system is injured and a hole is formed so that the contents of the digestive system can be spilled into the abdominal cavity. Unlike skin, the peritoneal stomach lining lacks a defense mechanism to fight infection. So the patient's life will be threatened when the bacteria that cause typhus spread to the stomach and infect the peritoneum. This condition is known as peritonitis.

Peritonitis is a serious illness because the peritoneum is usually sterile and free of germs. In this situation, the infection can spread rapidly through the blood to various other organs. This infection can cause various organs to stop functioning, even bringing death if not handled immediately.

The main sign of perforation is an unbearable stomachache . Other symptoms are infections in the blood (sepsis), nausea and vomiting. At the hospital, people with peritonitis will be treated with antibiotic injections before surgery to close the hole in the intestinal wall.

Typhus Prevention

Typhoid vaccination ( Typhus ) in Indonesia is included in childhood immunization schedule. This vaccination is highly recommended to be given to children aged two years to be repeated every three years. Vaccine is also ideally given a month before you visit a place that is typhoid endemic.

Some of the reactions and side effects that may appear and be felt after typhoid vaccine are:
  • Pain and redness or swelling around the injection area
  • Nausea
  • Dizzy
  • Stomach ache
  • Diarrhea
However, giving tifoid vaccine does not make every person vaccinated to 100 percent immune to this bacteria. The risk is still there, although the symptoms will not be as severe as those who have not been vaccinated.

Prevention Steps Besides Vaccines
Associated with countries in Asia, including Indonesia, is a typhoid endemic area. The disease is common in countries with poor hygiene and sanitation. In addition to Asia, countries in South and Central America, the Middle East, and Africa are also areas with high rates of typhoid fever.

Unfortunately in developing countries, the disease thrives as bacteria resistant levels rise against antibiotics to treat typhoid. This resulted in some antibiotics already unable to fight typhoid. Necessary preparation and dissemination of the list of drugs that are not effective so that patients get the right treatment.

To prevent this disease, typhoid vaccinations should be combined with improved sanitation and water supply, as well as healthy living habits. Note the following to avoid the risk of contracting typhoid:
  • Wash hands before and after processing food and drink, and after passing water or cleaning dirt, for example when washing cloth diapers. Use a hand-sanitizer if there is no water to wash your hands
  • If you are going to travel to a place that has a case of spreading typhus, you should make sure the water to be drunk is well boiled first
  • If you have to buy a drink, you should drink bottled water
  • Minimize consumption of food sold on the roadside because it is easily exposed to bacteria
  • Avoid ice cubes in your drink. Also should avoid buying and consuming ice cream sold on the street.
  • Avoid consumption of raw fruits and vegetables, unless you peel or wash them yourself with clean water.
  • Limit the consumption of culinary food (seafood) , especially those that have not been cooked.
  • You should use boiled water to brush your teeth or rinse, especially if you are in a place that is not guaranteed clean water.
  • Clean the toilet regularly. Avoid exchanging personal items, such as towels, bed linen, and toiletries. Wash the objects separately in warm water.
  • Avoid consumption of unpasteurized milk.
  • Always take antibiotics that your doctor prescribes and follow the instructions given. Antibiotic treatment should be performed until the treatment period ends to prevent drug resistance.

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