It seems like our old friend Typhoid is with us again as I hear several reports of outbreaks in the expatriate community. Let’s take a look at this relatively common tropical disease and see what we can do to reduce our risks of being exposed.
What is Typhoid fever?
Typhoid fever is a contagious bacterial disease, and my guess is that the major route of transmission in places like Bali is the fecal / oral route. It doesn’t take a genius to figure out how the locals clean themselves after their daily ablutions. How many public loos have you seen, that are equipped with a good supply of “dunny paper” and running hot water with soap? Yes, that’s right; it’s a “hands on” cleaning job for the best part of the population, and basic water and drip dry for your hands. So there rests my case. Typhoid fever occurs in epidemic proportions in this part of the world because of inadequate toileting hygiene, either through lack of knowledge (hand washing), or equipment (soap!). There are a total of 5 basic methods of transmission, which are referred to as the 5 “F”s:
-Flies.
-Feces.
-Food.
-Fingers
-Fornication.
What are the symptoms of Typhoid?
The symptoms of Typhoid most commonly experienced are:
-Fever
-Headache
-Rash
-Cough
-Malaise (no energy / feeling tired)
-Diarrhea OR constipation
-Loss of appetite
-Coated tongue
As you can see these symptoms could also indicate any one of a myriad of other diseases. Confirmation of Typhoid fever is best made with blood cultures (unfortunately these take 3-4 days). Another blood test called the WIDALis inconclusive at its best, and inaccurate at its worst, nevertheless it still gives us a reasonable indication, and is available the same day. The WIDAL should be repeated 7 days after the initial test to confirm diagnosis. (Note: those that have been immunized against Typhoid fever will show a falsely positive WIDAL test).
How is Typhoid treated?
Typhoid fever is treated with a course of antibiotics (for at least 14 days), and painkillers for headache and fever, (Note: Aspirin or other similar compounds should never be used, as they would aggravate any bleeding tendencies. Acetomenaphine, paracetamol, and codiene are safe). Despite its frequent occurrence here, this illness should not be taken lightly, as before the introduction of antibiotics; this disease claimed the lives of about 12% of its victims.
Prevention.
Avoid being exposed to the disease by:
-Checking personal hygiene, or the hygiene of your staff. (Note: Carriers of the disease may not always appear to be ill. They are “asymptomatic carriers”).
-A vaccine is available against Typhoid, however it is only 50 % - 80 % effective, and lasts for about 3 years.
-If you have suffered from Typhoid fever already, you may still contract the disease in the future (you are not immune).
*NOTE: The local term for “Typhoid Fever” is “Typhus”. This is a mishap of translation, as true “Typhus” is a completely different disease.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
