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Typhoid or Typhus?

…A case of “Po-tat-o or Po-tay-toe”?

I so often hear people say that they have had “Typhus” when in actual fact, they have not had “Typhus” at all, but “Typhoid”; two very different diseases, with different causes and treatment. The problem seems to lie in the translation. Indonesian medicos love the Latin pronunciation, hence the word “Typhoid” sounds much better when it is pronounced “Typhus”. The correct medical terminology for the diseases being “Salmonella Typhi” (Typhoid fever) and true Typhus may be classed under several categories of ricketsial diseases such as Endemic Typhus, Epidemic Typhus and Scrub Borne Typhus.

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 (no dunny paper in local toilets!). There are a total of 5 basic methods of transmission in all, which are referred to as the 5 “F”s: Flies, Feces, Food, Fingers & Fornication.

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.

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).

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).

What is Typhus?
As I mentioned before there are basically 3 different categories of Typhus.

Epidemic typhus
Epidemic typhus (also called “Jail Fever”, “Hospital Fever”, “Famine fever”, “Petechial Fever”, and “louse-borne typhus”) is so named because the disease often causes epidemics following wars and natural disasters. The causative organism is Rickettsia prowazekii, transmitted by the human body louse. Symptoms include severe headache, a sustained high fever, cough, rash, severe muscle pain, chills, falling blood pressure, stupor, sensitivity to light, and delirium. A rash begins on the chest about five days after the fever appears, and spreads to the trunk and extremities but does not reach the face, palms and soles. A symptom common to all forms of typhus is a fever which may reach 39°C (102°F). The infection is treated with antibiotics. Intravenous fluids and oxygen may be needed to stabilize the patient.

Endemic typhus
Endemic typhus (also called “flea-borne typhus” and “murine typhus” or “rat flea typhus”) is caused by the bacteria Rickettsia typhi, and is transmitted by the fleas that infest rats. Less often, endemic typhus is caused by Rickettsia felis and transmitted by fleas carried by cats or possums. Symptoms of endemic typhus include headache, fever, chills, myalgia, nausea, vomiting, and cough. Endemic typhus is highly treatable with antibiotics.

Scrub typhus
Scrub typhus (also called “chigger-borne typhus”) is caused by Orientia tsutsugamushi and transmitted by chiggers, which are found in areas of heavy scrub vegetation. This variety of typhus was known in Japan as tsutsugamushi disease, hence the formal name, and was also prevalent in Malaysia and Australia. Symptoms include fever, headache, muscle pain, cough, and gastrointestinal symptoms. More virulent strains of O. tsutsugamushi can cause hemorrhaging and intravascular coagulation.

Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 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 or Hp. 081 2366 0000.

Copyright © 2008 Kim Patra
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