Vaccinate Me!

1.06.2010 | Facts

Let’s see… Yellow Fever vaccination? Check. Tetanus, Diphtheria, and Polio vaccinations? Check. Hepatitis A vaccination? Check. Hepatitis B vaccination? Check. Fantastic! I don’t have to get any more needles before I go to Tanzania! That’s great because I *loathe* having needles. It scares the living daylights out of me for some reason, so I am very happy to avoid any further needl… hold on a second here…

Awww, man! Typhoid!? Are you kidding me!? Wait, wait, wait… maybe I can get away with not having this vaccination! Can Typhoid Fever be that common? Let’s have a look… hmmm, “endemic” in Tanzania. That’s not a word you want to see, is it? Ok, ok, but really, just how bad could Typhoid be, anyway?

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week.

In the second week of the infection, the patient lies prostrated with high fever in plateau around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of “nervous fever”. Rose spots appear on the lower chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea-soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major symptom of this fever is the fever usually rises in the afternoon up to the first and second week.)

In the third week of typhoid fever a number of complications can occur:
•Intestinal hemorrhage due to bleeding in congested Peyer’s patches; this can be very serious but is usually non-fatal.
•Intestinal perforation in distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
•Metastatic abscesses, cholecystitis, endocarditis and osteitis

The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing (defervescence). This carries on into the fourth and final week.

…Tomorrow I have an appointment at 2:45 at the Travel Clinic on Georgia St. downtown.