The typhoid fever is a disease through contaminated food and water with the bacterium Salmonella typhi. Its infection begins from the intestine and spreads throughout the body, which generates multiple gastrointestinal and systemic symptoms, and can have several relevant consequences in the lives of patients.
The complications of typhoid fever range from abscesses in various organs (caused by the spread and colonization of the bacteria) to intestinal perforation, bleeding, and infections of the central nervous system (meningitis), which can be fatal.
Although this disease does not have its own characteristic symptoms, there are endemic regions in America (especially Latin America), Africa, Asia and Oceania, where typhoid fever should be considered as a differential diagnosis in the presence of fever, constipation, cough, abdominal pain and enlargement of the liver and spleen, associated with muscle and joint pain.
To avoid the complications of typhoid fever, the doctor must initiate timely treatment.
How to treat typhoid fever?
It is important that when typhoid fever is suspected, the patient consults the doctor as soon as possible, in order to start antibiotic treatment immediately. The treatment of typhoid fever is based on treating its symptoms and also eliminating the bacteria that are causing the condition.
If the suspicion is high, due to the complications that typhoid fever can generate, the doctor should start an early antibiotic treatment, which should not be delayed while waiting for the confirmatory tests.
The antibiotic treatment of typhoid fever usually consists of the combination of third generation cephalosporin such as ceftriaxone associated with quinolones such as ciprofloxacin or levofloxacin (when there is no allergy to these antibiotics and if no bacterial resistance has been demonstrated in the region of where you go to the patient).
Other therapeutic options over the years have been chloramphenicol, amoxicillin, trimethopin sulfamethoxazole, and azithromycin, but in some places the bacteria have shown resistance to these treatments. The duration of treatment will depend on the severity, extending from 10 to 14 days.
In severe cases, antibiotic therapy should be extended to drugs with a broad therapeutic spectrum, in combination, using fourth-generation cephalosporin or carbapenems (such as imipenem).
On the other hand, the use of steroids in seriously ill patients is controversial, since some studies indicate that it reduces mortality in patients with Salmonella typhi meningitis, while other studies show that there are no statistical differences.
How to avoid complications of typhoid fever?
The main way to avoid typhoid fever complications is to receive timely and early treatment, as well as multidisciplinary care that includes the internist, the infectious disease doctor and, if necessary, the surgeon.
For those patients with hospitalization criteria, together with antibiotic treatment, nutritional support is described with a soft oral diet (if it is not contraindicated) and the use of intravenous hydration.
Hospitalized patients with typhoid fever should be isolated in the acute stage of the disease, restricting the number of visits from those close to them, and proper elimination of their feces and urine should be guaranteed, so that it cannot infect other people.
For hospitalized patients with intestinal perforation, surgery should be performed that involves draining and washing the peritoneal cavity and repairing the perforated intestinal segment. This surgery should be done emergency, in order to avoid peritonitis and a state of abdominal starting point sepsis.
In patients with typhoid fever, daily medical surveillance should be carried out in order to detect neurological changes that could correspond to symptoms of meningitis early.
Another point to take into account to avoid complications of typhoid fever is that the doctor must request blood, stool and urine cultures, which determine the sensitivity of the bacteria to the antibiotic that has been decided to use. If the bacteria shows any resistance to the treatment used, then a substitute that is adapted to the sensitivity of the germ should be indicated.
How to avoid typhoid infection?
In view of the fact that typhoid fever is a disease that is transmitted via the fecal - oral route (through water, food and hands contaminated with feces containing the bacteria), the recommendations are based on the correct handling of food, the consumption of water drinking and hand washing (before eating and after evacuating).
In addition, it is recommended not to consume frozen or canned food after the expiration date of its preservation. Correct cooking of foods such as eggs, meat, seafood and chicken is also recommended.
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