TYPHOID (ENTERIC) FEVER AND PARATYPHOID FEVER

 

Anaclare Cobb, RN, BS, MSN, FNP

 

Typhoid fever is a bacterial infection caused by Salmonella typhi and Paratyphoid fever by Salmonella paratyphi. They have similar symptoms and are spread through fecally-contaminated food and water, or by direct contact with an infected person. According to the World Health Organization (WHO), 9 million people were affected by typhoid and paratyphoid illnesses in 2019. The WHO further estimates that 110,000 people die from the illness each year.

 

Symptoms of typhoid fever include:

 

• Protracted fever
• Fatigue
• Headache
• Nausea
• Abdominal pain
• Constipation or diarrhea
• A flat rash, often described as “rose spots”

 

Severe disease is caused by spreading infection, bowel perforation, and bacteremia.  Paratyphoid is similar in presentation to typhoid but generally less severe.  If left untreated, even if symptoms resolve, the ill person may remain contagious by spreading the bacterium through their feces.

 

Typhoid fever and paratyphoid fever are treated with antibiotics.  The antibiotics most commonly used are:

 

• Fluoroquinolones such as ciprofloxacin
• Cephalosporins (third generation)
• Macrolides
• Carbapenems

 

Gastrointestinal precautions must be kept in place until the ill person’s cultures are clear of infection.  Additionally, the infected individual should avoid food preparation and practice frequent handwashing until clearance has been given.

 

Two typhoid conjugate vaccines were prequalified by the WHO. The vaccines are recommended for individuals aged six months to 65 years.

 

Typhoid and paratyphoid fever are diseases that can generally be treated with prompt care. Recognition of the symptoms and an understanding of the potential dangers of infection are paramount.  Remember that children do not tolerate the ravages of typhoid bacteremia and should be cared for promptly.

 

Sources:

 

“Typhoid.” World Health Organization, World Health Organization, 30 Mar. 2023, www.who.int/news-room/fact-sheets/detail/typhoid

“Typhoid Fever.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 Jan. 2023, www.mayoclinic.org/diseases-conditions/typhoid-fever/symptoms-causes/syc-20378661.

“Typhoid Fever and Paratyphoid Fever.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Dec. 2022, www.cdc.gov/typhoid-fever/symptoms.html.

Wolf, Catherine, and Dennis Palmer. Handbook of Medicine in Developing Countries, 4th ed., Christian Medical & Dental Associations, Bristol, TN, 2014, pp. 35–37.

http://www.mfhhospital.org/malaria-in-ghana/1270-2/

 

MALARIA IN GHANA

Anaclare Cobb, RN, BS, MSN, FNP

 

The World Health Organization (WHO) reports that malaria affects at least 85 countries in the world.  They estimate that in 2021, there were over 240 million cases of malaria, with 624,000 individuals succumbing to the illness worldwide.  Children are most affected by the illness, with the largest number of deaths being from the pediatric population.  Complete immunity to the disease does not occur, but children, who have had the least amount of exposure to the disease, are most vulnerable to the potential severity of the illness.

 

Malaria is transmitted by the female Anopheles mosquito.  It is caused by five species of the parasite Plasmodium, with P. falciparum being the most common in Ghana. P. falciparum also causes the most serious illness of the five species. The malaria parasite is transmitted to the human host when the person is bitten by the disease-carrying mosquito. It takes 7 to 30 days for the infected person to show signs of illness. Once introduced into the bloodstream, the parasites travel to the liver, where they grow, multiply and then travel to the red blood cells. There, the parasites continue to grow and eventually rupture through the red blood cells, leading to anemia for the host. Disease is caused by the sheer number of the parasites as they multiply.

 

Symptoms of malaria may vary, but are categorized as uncomplicated or severe.

 

UNCOMPLICATED

•     Fever
•     Chills/sensation of feeling cold
•     Body aches
•     Headache
•     Nausea, vomiting and/or diarrhea.
•     Weakness

 

     SEVERE

•     All of the above
•     Abdominal pain
•     Impaired consciousness
•     seizures
•     abnormal behavior
•     Anemia
•     Respiratory distress
•     Kidney disease
•     Low blood sugar
•     Jaundice
•     Bleeding (nose, gingiva, bowels)

    

Symptoms of severe malaria are considered a medical emergency.  Medical care must be sought immediately.

 

Treatment is guided by whether the person has symptoms of uncomplicated or severe malaria.

Uncomplicated malaria is treated with oral antimalarial medications, antipyretics, and antiemetics. In Ghana, a combination of drugs is typically given for uncomplicated malaria:  artesunate and lumefantrine. These medications are generally well tolerated and are taken for a total of three days. Adults are given a standard dose of four tablets, twice a day. and a Children’s dosage will vary, depending on the child’s weight. Pregnant women in the first trimester may be treated with seven days of quinine and clindamycin. During the second and third trimesters of pregnancy, they are given artesunate and lumefantrine for uncomplicated malaria.

 

For cases of severe malaria, hospital treatment is essential.  An intravenous artemisinin derivative is given for at least 24 hours. Once stable, the person may be started on oral medications. Underlying complications such as anemia, respiratory distress, kidney injury and hypoglycemia are managed accordingly.

 

Women who are pregnant are more likely to experience severe malaria.  The malaria parasites attack the placenta, which can cause advanced anemia, low birth weight, premature labor and even fetal death.  Therefore, pregnant women must be treated more aggressively. The WHO recommends prophylactic antimalarial medications to be given at predetermined intervals throughout the pregnancy, along with discussions on home precautions to prevent mosquito bites.  These include, but are not limited to, the use of treated mosquito netting.

 

As the world battles the ravages of malaria, hope is on the horizon. In October 2021, the WHO released its position paper and recommendation for the RTS,S vaccine for children. The vaccine targets the malaria-causing parasite Plasmodium falciparum.  The WHO recommends a 4-5 series immunization schedule before the age of one. It is estimated that the vaccine will prevent tens of thousands of deaths each year. The WHO has initiated the RTS,S vaccine program in three counties: Ghana, Kenya and Malawi. Over 1.7 million doses have been given and the vaccine has proven to be safe and effective.

 

With continued advances, malaria may become a disease of the past. Until then, we must all be vigilant in maintaining preventive measures and seeking treatment with the onset of any potential symptoms.

 

Works Cited

 

World malaria report 2021. Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO.

“Fact Sheet about Malaria.” World Health Organization, World Health Organization, 29 Mar. 2023, www.who.int/news-room/fact-sheets/detail/malaria.

 

 

 

 

The Methodist Faith Healing Hospital (M.F.H.H)-Ankaase Organised a one day Cardio-Clinic on the 11th September, 2017 in Partnership with Mayo-Clinic, U.S.A. department of Cardiology; which is first time in the Hospital’s history. The Clinic was mainly for patients with atrial fibrillation, CCF/HC and Cardioversions and its relations. The Cardiologist from the Mayo-Clinic came with Echocardiogram Machine to enhance diagnosing and treatment as well as Electrocardiogram (ECG/EKG). Attendance on the day exceeded the expected number. The turn out was overwhelming.

On Tuesday June 6 2017, hospital staff joined board members and other dignitaries in unveiling the recently completed 6-bedroom hostel facility in Ankaase in the Afigya Kwabre district of the Ashanti region.
The facility’s completion was made possible by funds from the Methodist church-Kumasi diocese, The Mission Society (TMS) Global, Surgeon Noonan society and the Methodist Faith Healing hospital.

The new multipurpose hostel has the capacity to host 14 people at one time. It is also manned by 24-hour security personnel in addition to high quality CCTV monitoring. As part of the high security standards, four 440 Watt street lights illuminate the hostel’s surroundings at night. Backup electrical supply in case of power outage is provided by a state of the art electrical generator.

Speaking at the unveiling ceremony, the Kumasi Diocese Bishop, Rt. Rev. Christopher Andam urged community members to help the hospital in protecting and securing its facilities as it benefits not only the Ankaase community, but also the Afigya Kwabre district. He also praised the efforts of the workers whose hard work and perseverance through difficult times made this project a reality.

The chief executive officer, Mr. Joseph Atta Amankwaa spoke about the need to improve the road network leading to the hospital. The terrible nature of the roads makes it a difficult commute especially in emergency situations where patients had to be referred to Komfo Anokye Teaching Hospital, the only tertiary hospital in the region. In addition, he humbly asked the NHIS representatives present at the unveiling to help facilitate insurance funds reimbursement to the hospital as the current nature of affairs were making it exceedingly difficult to operate affairs at the hospital. The hospital provided care for over 60,000 patients last year and is on course to do the same this year. The last time the hospital received NHIS funds were for May 2016 insurance reimbursement.

The new hostel will be used to host two groups of students in June-July 2017. The first group, TMS global, are part
of the greenlight program. The greenlight program is designed for students who are interested in cross cultural ministry. Students in the greenlight program, all from the United States, will be led by Dr. Cameron Gongwer.
The second group, Surgeon Noonan, are a group of medical students from Ireland who will be using the hospital as a site to learn more about tropical medicine as part of their 4th year medical school elective studies.

The hospital is excited to host and partner with these groups in promoting health locally and internationally. The new hostel is open to all interested groups and individuals willing to patronize the facility. For more pictures of the hostel please visit the gallery section of our webpage.

Please visit our contact us page or email us at info@mfhhospital.org, for more information about the hostel and other services we offer.