TYPHOID DURING PREGNANCY

1. INTRODUCTION
1.1. Background

Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic

illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and,
to a lesser extent, related serovars paratyphi A, B, and C.

The protean manifestations of typhoid fever make this disease a true diagnostic
challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and
constipation. Untreated, typhoid fever is a grueling illness that may progress to
delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1
month of onset. Survivors may be left with long-term or permanent neuropsychiatric
complications.

Salmonella typhi has been a major human pathogen for thousands of years,
thriving in conditions of poor sanitation, crowding, and social chaos. It may have
responsible for the Great Plague of Athens at the end of the Pelopennesian War. The
name S typhi is derived from the ancient Greek typhos, an ethereal smoke or cloud that
was believed to cause disease and madness. In the advanced stages of typhoid fever, the
patient's level of consciousness is truly clouded. Although antibiotics have markedly
reduced the frequency of typhoid fever in the developed world, it remains endemic in
developing countries.

Salmonella paratyphi causes the same syndrome but appears to be a relative

newcomer. It may be taking over the typhi niche, in part, because of immunological
naivete among the population and incomplete coverage by vaccines that target typhi.

Note that some writers refer to the typhoid and paratyphoid fever as distinct
syndromes caused by the typhi versus paratyphi serovars, while others use the term
typhoid fever for a disease caused by either one. We use the latter terminology. We refer
to these serovars collectively as typhoidal salmonella.
2. DEFINITION AND SYMPTOMS
2.1. Definition
Typhoid fever (sometimes called enteric fever) is a bacterial infection, caused by
salmonella typhi. Salmonella typhi is related to the bacteria that cause salmonella food
poisoning. Once the bacteria enter the body, they multiply and spread from the
intestines, into the bloodstream, affecting many organs. Another infection called
paratyphoid fever has similar symptoms to typhoid fever but is generally considered to
be a milder disease.
Typhoid fever and paratyphoid fever are caused by related but different strains of
salmonella bacteria. Paratyphoid fever is caused by salmonella paratyphi, and appears
to be a newer strain of the disease. Paratyphi is more commonly transmitted in food
from street vendors, especially food that isn't prepared or stored hygienically.

Typhoid is an infection caused by Salmonella typhimurium bacteria that is spread

from human to human. Typhoid is an infection caused by the bacteria Salmonella
typhimurium. The bacterium lives in the intestines and bloodstream of humans. It is
spread between individuals by direct contact with the feces of an infected person. No
animals carry this disease, so transmission is always human to human.

If untreated, around 1 in 4 cases of typhoid end in death. If treatment is given,

less than 4 in 100 cases are fatal. S. typhi enters through the mouth and spends 1-3
weeks in the intestine. After this time, it makes its way through the intestinal wall and
into the bloodstream.

From the bloodstream, it spreads into other tissues and organs. The immune
system of the host can do little to fight back because S. typhi can live within the host's
cells, safe from the immune system. Typhoid is diagnosed by detecting the presence
of S. typhi via blood, stool, urine, or bone marrow sample.

2.2. Symptoms

Signs and symptoms are likely to develop gradually often appearing one to three
weeks after exposure to the disease.

a) Early illness
Once signs and symptoms do appear, you're likely to experience:
 Fever that starts low and increases daily, possibly reaching as high as 104.9 F
(40.5 C)

Headache

Weakness and fatigue

Muscle aches

Sweating

Dry cough

Loss of appetite and weight loss

Abdominal pain

Diarrhea or constipation

Rash

Extremely swollen abdomen

b) Later illness

If you don't receive treatment, you may:

Become delirious

Lie motionless and exhausted with your eyes half-closed in what's known as
the typhoid state

In addition, life-threatening complications often develop at this time. In some people,

signs and symptoms may return up to two weeks after the fever has subsided.

3. ASPECTS THAT CAN CAUSE OF TYPHOID

3.1. Aspects can cause of Typhoid
 Typhoid fever or enteric fever is a life threatening and serious infection
occurring in developing nations due to the scarcity of cleanliness and other
sanitation measures. The acute infection is caused by Salmonella typhi. A milder
form of infection, Paratyphoid is caused by Salmonella paratyphi bacteria through
contaminated food, especially the food that has not been cooked or stored properly.
Living in unsanitary conditions or drinking contaminated water can increase your
chances of getting typhoid in pregnancy.

Salmonella is notoriously famous for causing abortion especially if left

untreated. The infection can reach the baby to potentially put you at a risk of
miscarriage, pre-mature birth or a low birth weight baby. Septic and early second
trimester abortions are often seen in typhoid affected pregnant women. Because
most typhoid patients are restricted to liquid diet, there is a good chance that you and
your baby miss out on healthy nutrition.

If the typhoid affected pregnant woman receives proper treatment the child
born is usually healthy and safe.

4. THE MEDICAL TREATMENTS

4.1. The medical treatments

The only effective treatment for typhoid is antibiotics. The most commonly
used are ciprofloxacin (for non-pregnant adults) and ceftriaxone. Other than
antibiotics, it is sensible to rehydrate by drinking adequate water.

The treatment of enteric fever is mainly with antibiotics that destroy the
Salmonella bacteria but the use of antibiotics is restricted during pregnancy and this
is the main problem with typhoid treatment during pregnancy. If you notice high
grade fever immediately report it to your obstetrician for further diagnosis and
proactive treatment.

If left untreated, typhoid fever might last for a month or even more so
immediate treatment is very important. It becomes fatal and can cause death.

Delaying treatment will make recovery time longer and also increase the risk
of developing complications. So your doctor might not wait for the results of tests
 before starting the antibiotics course. Once typhoid is diagnosed and confirmed,
your doctor may decide to change the particular type of antibiotic you are taking.
More serious cases of typhoid fever usually require admission to hospital so
antibiotic injections can be given. In more severe cases, where the bowel has
become perforated, surgery may be required.

5. THE PREVENTIONS
5.1. The preventions

In many developing nations, the public health goals that can help prevent and
control typhoid fever safe drinking water, improved sanitation and adequate
medical care may be difficult to achieve. For that reason, some experts believe
that vaccinating high-risk populations is the best way to control typhoid fever.

A vaccine is recommended if you're traveling to areas where the risk of getting

typhoid fever is high.

1) Vaccines
Two vaccines are available.
1. One is injected in a single dose at least one week before travel.
2. One is given orally in four capsules, with one capsule to be taken every
other day.

Neither vaccine is 100 percent effective, and both require repeat

immunizations, as vaccine effectiveness diminishes over time.

Because the vaccine won't provide complete protection, follow these

guidelines when traveling to high-risk areas:

1. Wash your hands. Frequent hand-washing in hot, soapy water is the best way
to control infection. Wash before eating or preparing food and after using the
toilet. Carry an alcohol-based hand sanitizer for times when water isn't
available.
2. Avoid drinking untreated water. Contaminated drinking water is a particular
problem in areas where typhoid fever is endemic. For that reason, drink only
bottled water or canned or bottled carbonated beverages, wine and beer.
Carbonated bottled water is safer than uncarbonated bottled water is.
 Ask for drinks without ice. Use bottled water to brush your teeth, and try not to
swallow water in the shower.
3. Avoid raw fruits and vegetables. Because raw produce may have been
washed in unsafe water, avoid fruits and vegetables that you can't peel,
especially lettuce. To be absolutely safe, you may want to avoid raw foods
entirely.
4. Choose hot foods. Avoid food that's stored or served at room temperature.
Steaming hot foods are best. And although there's no guarantee that meals
served at the finest restaurants are safe, it's best to avoid food from street
vendors it's more likely to be contaminated.

2) Prevent infecting others

If you're recovering from typhoid fever, these measures can help keep others
safe:

1. Take your antibiotics. Follow your doctor's instructions for taking your
antibiotics, and be sure to finish the entire prescription.
2. Wash your hands often. This is the single most important thing you can do
to keep from spreading the infection to others. Use hot, soapy water and
scrub thoroughly for at least 30 seconds, especially before eating and after
using the toilet.
3. Avoid handling food. Avoid preparing food for others until your doctor says
you're no longer contagious. If you work in the food service industry or a
health care facility, you won't be allowed to return to work until tests show
that you're no longer shedding typhoid bacteria.

6. CONCLUSION
Typhoid fever (sometimes called enteric fever) is a bacterial infection, caused by
salmonella typhi. Salmonella typhi is related to the bacteria that cause salmonella food
poisoning. Once the bacteria enter the body, they multiply and spread from the
intestines, into the bloodstream, affecting many organs. Another infection called
paratyphoid fever has similar symptoms to typhoid fever but is generally considered to
be a milder disease.

Typhoid is an infection caused by Salmonella typhimurium bacteria that is spread

from human to human. Typhoid is an infection caused by the bacteria Salmonella
typhimurium. The bacterium lives in the intestines and bloodstream of humans. It is
spread between individuals by direct contact with the feces of an infected person. No
animals carry this disease, so transmission is always human to human.

Signs and symptoms are likely to develop gradually often appearing one to
three weeks after exposure to the disease.

Fever that starts low and increases daily, possibly reaching as high as 104.9 F
(40.5 C)

Headache

Weakness and fatigue

Muscle aches

Sweating

Dry cough

Loss of appetite and weight loss

Abdominal pain

Diarrhea or constipation

Rash

Extremely swollen abdomen

Typhoid fever or enteric fever is a life threatening and serious infection occurring
in developing nations due to the scarcity of cleanliness and other sanitation measures.
The acute infection is caused by Salmonella typhi. A milder form of infection,
Paratyphoid is caused by Salmonella paratyphi bacteria through contaminated food,
especially the food that has not been cooked or stored properly. Living in unsanitary
conditions or drinking contaminated water can increase your chances of getting typhoid
in pregnancy.
 The only effective treatment for typhoid is antibiotics. The most commonly used
are ciprofloxacin (for non-pregnant adults) and ceftriaxone. Other than antibiotics, it is
sensible to rehydrate by drinking adequate water.

Because the vaccine won't provide complete protection, follow these guidelines
when traveling to high-risk areas:

1. Wash your hands. Frequent hand-washing in hot, soapy water is the best way
to control infection. Wash before eating or preparing food and after using the
toilet. Carry an alcohol-based hand sanitizer for times when water isn't
available.
2. Avoid drinking untreated water. Contaminated drinking water is a particular
problem in areas where typhoid fever is endemic. For that reason, drink only
bottled water or canned or bottled carbonated beverages, wine and beer.
Carbonated bottled water is safer than uncarbonated bottled water is.
Ask for drinks without ice. Use bottled water to brush your teeth, and try not to
swallow water in the shower.
3. Avoid raw fruits and vegetables. Because raw produce may have been
washed in unsafe water, avoid fruits and vegetables that you can't peel,
especially lettuce. To be absolutely safe, you may want to avoid raw foods
entirely.
4. Choose hot foods. Avoid food that's stored or served at room temperature.
Steaming hot foods are best. And although there's no guarantee that meals
served at the finest restaurants are safe, it's best to avoid food from street
vendors it's more likely to be contaminated.
7. REFERENCES
Sulaiman K, Sarwari AR. Culture confirmed typhoid fever and pregnancy. Int J
Infect Dis 2007;11:33741 [PubMed]
Seoud M, Saade G, Uwaydah M, Azoury R. Typhoid fever in pregnancy. Obstet
Gynecol 1988;71:7114 [PubMed]
http://www.babycenter.in/a25016267/typhoid-in-pregnancy
https://www.ncbi.nlm.nih.gov/pubmed/6335838