By Tedler D. Depaynos, MD
rural areas.”
We were lectured many decades ago that patients having fever for more than 5 days with the cause not obvious after a complete history taking and thorough physical examination was called “fever of unknown origin”. The prevalent diseases during that time were malaria, tuberculosis and typhoid fever so they were always considered or ruled out as the causes before further work ups were done.
With malaria getting rare nowadays except in endemic places and with the incidence of tuberculosis decreasing due to the extensive program of DOH, only typhoid fever now remains to be a major consideration. Other new prevalent diseases like Dengue and Chikongunya, however, are now presently included in the differential diagnosis together with Tuberculosis again due to the recent resurgence of its incidence according to some pulmonologists.
It is therefore routine for patients with “fever of unknown” origin to have a chest x-ray and blood tests for Typhoid Fever and Dengue. If they turn out to be negative they are usually referred to other disease specialists.
Typhoid fever is due to the bacteria Salmonella Typhi which is one of the serious “Enteric Bacteria” that usually affect the gastro-intestinal tract. Hence, classically the manifestations of Typhoid Fever are high fever with diarrhea and sometimes constipation, nausea and vomiting and abdominal pain. In severe cases when the gastro-intestinal tract is severely inflamed, bleeding and even perforation may occur which are considered as unfortunate severe complications.
Fever in this disease entity may be persistently severe associated with unremitting headache, chills, body pains and malaise and dehydration. Many cases, however, do not manifest the classical signs and symptoms and just appear like a simple Systemic Viral Diseases. In contrast, however, viral diseases usually last only for 3 to 5 days but Typhoid Fever may last beyond that and may even persist for weeks or months.
The disease is spread through the fecal–oral route so that sanitation is a must. Those who apparently recovered from the disease may become carriers for even a year with their stools always positive with the typhoid bacteria. It is dangerous if they become food handlers. You can just imagine if they get employed in popular fast food outlets mostly patronized by young individuals. Hence, strict pre-employment medical examination should be a requirement.
Medicines for the fever, body aches, malaise and hyperacidity are routinely given with hydration as a must. Chloramphenicol used to be the standard antibiotic for the Salmonella bacteria but with the appearance of resistant strains and possible blood complication termed agranulocytosis, this is prescribed only with care and no longer routinely by many specialists. Hence medical consultation for prolonged fever is recommended and the intake of chloramphenicol must be done with caution. Unfortunately, sometimes it is the only antibiotic available and affordable in the rural areas.**
