Typhoid Fever and the Food You Eat Outside

By Dr. Okechukwu Amako, MBBS (Ibadan)
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A lot of people virtually depend on restaurants and street food vendors for their daily food. They leave the house early in the morning for their workplace; by midday, they look for one restaurant to go eat in or beckon on the regular food vendors on the street to buy food. They do this almost daily and everything is fine. Then something happens.

One guy who regularly eats outside--buys food from food hawkers and sometimes goes to a restaurant to eat--starts having a fever. This fever becomes very high as the day goes by and then falls the next morning to start rising again as the day progresses. This continues for about 5 days, and a week later, the guy starts having pain all over his abdomen (tummy); he feels like vomiting sometimes and finds it difficult to defecate.

The young man thinks he has both malaria and worm infection and decides to buy an anti-malarial drug, Flagyl for the worm and a pain reliever (paracetamol) for the abdominal pain. After taking these medications over the next one week, he didn't experience any improvement.

Instead, this guy begins to feel a very tightening pain at the right upper side of his abdomen and he notices that his abdomen is gradually getting bigger than normal. He has lost appetite for food, feels weak most of the time, people tell him he is losing weight, and whenever he manages to defecate, the stool passed out is a foul-smelling, green-yellow liquid.

This young man could have died in the next few weeks if a friend of his didn't persuade and accompany him to see a doctor in a hospital. After asking him different questions, the doctor took a sample of his blood, urine, and stool (faeces) for lab tests. The doctor then placed him on some antibiotics while awaiting the result of the lab tests. When the result came out, it showed he had typhoid fever. Based on the history he gave the doctor it was very likely he got it from eating contaminated food from either one of the restaurants or food hawkers.

Typhoid fever is a disease caused by a bacterial organism called Salmonella typhi. It can affect many, if not all, systems in the body and it can kill the person infected within one month if he or she doesn't receive the right medical treatment.

If untreated, a person with typhoid fever can develop complications like intestinal bleeding and rupture of the intestine. He or she can also become mentally confused and begin to see or hear things that are not in the environment in reality (psychosis); this impact on the mental status of the affected individual can be long-term or permanent.

Some people with typhoid fever and who don't receive treatment may go on to survive and not manifest any symptoms again. But they become chronic carriers of the Salmonella typhi organism, meaning the bacteria stay in their system for years (over ten years or indefinite) without causing any symptoms and they pass them out in the faeces and urine. This group of people is the major source of infection of healthy people who go on to develop typhoid fever:

1. If someone who has a restaurant or sells food on the street is a chronic carrier of the typhoid fever bacteria, he or she is likely to pass on the bacteria to anyone who buys food from him or her. This occurs if this person doesn't wash his or her hands properly with soap and water after using the toilet or urinating and then handles food or water meant for other people.

2. Another way a healthy person can get typhoid fever is by not washing his or her hands properly after using a public toilet which a chronic carrier of the typhoid fever bacteria may have used. Eating food with those poorly washed hands increases the risk of typhoid fever in the person.

3. Drinking water from unknown or unhygienic sources is a risk factor for getting typhoid fever because that water could come from a source where people urinate or defecate frequently.

To prevent typhoid fever:

1. Avoid eating food from food hawkers on the street and be very selective in terms of the restaurant to eat in: however, the most effective way here is to prepare one's own food at home. Although this may be very challenging for a lot of people who depend on eating outside, it is the most effective way to prevent the disease.

Wash any raw food items you buy and cook them very well before eating.

2. Minimize the use of public toilets, and if you must use one, wash your hands thoroughly with soap and water immediately after and before eating.

3. Always boil water before drinking unless it is bottled water.

If you have some of the above symptoms (of typhoid fever) and you regularly eat outside, drink water from public sources without boiling it or use public toilets frequently, you may have typhoid fever. You should see a doctor at once. After treatment, your doctor will likely want to follow you up for the next 3 months to monitor you for any complications of typhoid fever and a possible reoccurrence of the typhoid fever.

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Published Monday, June 5th 2017

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