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Typhoid fever (The Enteric Fever) - Dr. Deoshlok Sharma

Typhoid fever (The Enteric Fever)

Def: It is an acute infective disease characterized by continued fever, splenomegaly, bacillaemia, involvement of intestinal lymphatic tissue and usually a roseolar eruption.

Aetiology- Causative organism- Salmonella Typhi (a gram negative bacillus) .Predisposing cause : Age –5 to 35 years. Sex- both, males prcdominate, Season- mostly autumn. Incubation period about 10 to 14 days.
Source of infection: Food, flies, fingers, faces, filth and fomite etc.

Pathogenesis: After a few days of bacteremia, the bacilli localize mainly in the lymphoid tissue of the small intestine. The typical lesson is in the peyer’s patches and follicles. These swell at first, them ulcerate and ultimate heal, but during this sequence they may perforate or bleed. The mesenteric lymph nodes and spleen are enlarged.

Clinical Features: Onset is insidious.
Stage of invasion (1st week)-1. Temperature rises in a step ladder fashion with a progressive evening rise and ½ to 1 drop each morning, face flushed. 2. Relative bradycardia with dicrotic pules. 3. Coated tongue with red margins and tip. 4. Headache, constipation, loss of appetite, lassitude, malaise. 5. Abdomen swollen with gurgling over caecum, may be pain and discomfort. 6. Spleen just palpable. 7. Rash may appear at the end of week.

State of Fastigium (2nd week)-1. Temperature continuous but high. 2. Headache less marked, becomes mentally dull, week and stuporose. 3. Constipation replaced by peasoup diarrhoea. 4. Dry coated tongue, pulse shows tachycardia, cough may supervene. 5. Distended abdomen and tender on palpation.6. Spleen enlarged and liver may just palpable. 7. Rashes may be present. 8. Evidence of bronchitis and bronchopneumonia (sometime). 9. Muttering delirium, coma and vigil may be present at the end of 2nd week.

Stage of Defervescence (3rd week) – 1. More exhausted, delirium and muscular twitching. 2. Dry and shiny tongue. 3. Muscular wasting. 4. Homorrhage and perforation may occur. 5. Abdomen more distended. 6.Temperature begins to fall by lysis (rarely bycrisis).


Stage of Convalescence (4th week) –1. Temperature normal in the mornings, a little higher in the evening. 2. Abdominal reflexes reappear. 3. Spleen not palpable. [3rd and 4th week-various complications gradually develop. But fortunately now-a-days these] stages are not seen.

Investigations:- Typhoid fever may be mistaken for Influenza Gastroenteritis, Pneumonia, Nephritis or Meningitis.
1st week: 1. Blood culture – positive.
2.Leucocytecount – leucopenia with relative lyucocytosis.
2nd week: 1. Widal’stest is positive.
3rd and 4th week: 1. Widal’s test positive.2. Stool and urine culture positive.

Complications: 1. Intestinal – haemorrhage, perforation and peritonitis. 2. Venous thrombosis. 3. Respiratory – laryngitis, bronchitis, pneumonia, pleural effusion, lung abscess. 4. Cardiac – myocarditis, endocarditis and pericarditis, acute peripheral circulatory failure. 5. Nervous, - Meningitis, convulsion, coma, delirium post-typhoid insanity, typhoid state, meningism, neuritis osteomy-elitis, spondylitis etc.

The Typhoid State:- It is a condition of extreme prostration, often with semi consciousness and delirium, which may rise in any toxaemia of sufficient gravity . The patient may be comatose, restless and confused, with dry skin and sores (crusted sores) around the mouth, also may be incontinent of urine and faces. It is seen in severe toxanemia , viz. typhoid or Typhus fever, Acute Lobar Pneumonia, Acute Pulmonary
tuberculosis, infective endocarditis, Acute meni
ngitis, Encephalitis lethargica.

Treatment of Typhoid Fever: - Prophylaxis – T.A.B. Vaccine 1ml. subcutaneously, repeated after 10 days.

Curative -1. General nursing care including mouth, eyes and skin are important. 2. Bed rest until temperature is normal for 2 weeks. 3. Diet should be high caloric and in the form of liquids. 4. Milk horlicks, fluid and electrolytic balance to be maintained. 5. Purgatives should never the prescribed. 6. For high temperature tepid sponging advised.

HOMOEOPATHIC REMEDIES FOR TYPHOID FEVER:

Gelsemium – In early stage. Typhoid fever, when so-called nervous symptoms predominate. Great fullness in head, with heat or face and chilliness. Head feels too big. Tongue yellowish white or thick brown. Nervous chills, with chattering of teeth and fever without thirst.
Baptisia: Incipient stage, Face dark red, with a besotted expression. Dull, stupefying headache, with confusion of ideas. Head feels as if scattered around. Patient tosses about toget pieces together. Tongue coated brown, dry, particularly in center. All discharges are very offensive.
Pyrogen: Severe septicanemia,the bed feels hard, parts laid on feels sore and bruishes, great restlessness. Tongue large flabby, clean smooth as if varnished, constipation, stool large, black, carrion like, pulse abnormally rapid out of all proportions to temperature.
Hamamelis: Typhoid fever, with bloody orifis. Profuse hanemorrhage from blood black, partly coagulated and offensive, with a bruised, sore feeling in abdomen and hips. Epistaxis, flow passive.

BIOCHEMIC REMEDIES FOR TYPHOID FEVER:

Ferrum phos – Typhoid or gastric fever when commencing; initiatory stage for chilliness. The patient has a full, flushed face and the lips and mucous membranes are red. The pulse is more rapid, but stronger and less irregular than under Kali phosphorium.
Kli mur – Typhoid or gastric fevers, for gray or white coated tongue and looseness of the bowels, with light-yellow, ochre-colored stools or floccuent evacuations, and for abdominal tenderness and swelling.

Kali sulph – Typhoid or gastric fever, with a rise of temperature at night and a fall in the morning.

Natrum mur – Typhoid or malignant conditions during the course of any fever, such as twitchings with great drawsiness, watery vomiting, spoor, parched tongue, etc.

Calcarea phos – After typhoid or gastric fevers as the disease declines.

Dr. Deoshlok Sharma
 
  deoshlok on 2006-11-15
This is just a forum. Assume posts are not from medical professionals.
Dear Dr. Deoshlok,
Thanks for your post.

Recently I cured a child having Typhoid Fever with Baptisia Mother Tincture.
Recovery was very quick.
Have used Baptisia for Typhoid most times.

An eminent Indian Homeopath has suggested following meds for Typhoid in his book:

Muriatic Acid; Pyrogen; Baptisia; Arnica ; Rhus Tox;
Hyoscomus >> when brain is involved
Belladona >> when face is red.

(According to symtoms).

Best wishes,
Pankaj Varma
 
PANKAJ VARMA last decade
Fever, continued fever, typhus, typhoid :

agar., ail., am-c., anthr., apis., arg-n., arn., ars., arum-t., bapt., bry., calad., calc., camph., canth., caps., carb-ac., carb-an., carb-v., cham., chel., chin-a., chin-s., chin., chlor., cic., cocc., colch., crot-h., echi., gels., hell., hydr-ac., hyos., iod., ip., kali-p., lach., lyc., lycps., mang., merc., mosch., mur-ac., nit-ac., nux-m., op., petr., ph-ac., phos., psor., puls., pyrog., rhus-t., rhus-v., sang., sec., sil., stram., sul-ac., sulph., ter., verat-v., verat., zinc.

This is from Kent.

Murthy
 
gavinimurthy last decade
Belladona for typhoid??

My dear sir

Belladona's fever comes so rapidly, that it doesn't have any resemblance with typhoid.

Typhoid has slow onset, and continued fever.

May I know who is that author?

Murthy
 
gavinimurthy last decade
This is from Kent.

Fever: Bell. has no continued fever in it.

Its fever is remittent. It never comes on in its complaints gradually like typhoid. It has not the gradual rise and the gradual fall like a continued fever.

I only mention that so that you will not be lost.

When you give Bell. for the delirium in typhoid fever - for such a delirium as looks like Bell. - you may subdue the delirium, but other manifestations will rise in that fever.

You will not subdue the fever, but you will subdue the patient. The patient will be sick longer, will go into a greater state of prostration than if you had let that delirium alone.

But Stramonium fits perfectly in such cases.

Murthy
 
gavinimurthy last decade
Some modern repertories do give bell as a possible medicine for typhoid,but that is why all modern repertories are not that reliable.

They just include names of medicines,suggested by each and every doctor, without much verification.

You should always read the materia medica,and confirm the medicine,even after selecting the medicine by using reperory.

finally you have to match the patient to the drug. Repertories, softwares are only aids.

Finally it is your intelligence which matters.

Murthy
 
gavinimurthy last decade
Dear Gavini, I have another friend Murthy, But he is very intelligent.
 
kuldeep last decade
suffering from Typhoid fever. On 15th Oct fever was felt and controlled by taking one Crocin tablet.
But on 19th it came back, rises upto 100, then 102 then 103 and not controlled by Crocin. In the evening Doctor prescribed Paracetamol 650, Polyphede and one more medicine. Temperature not controlled and goes to 103 degree Farenheit. On 20th temp came down using wet cloths on forehead, neck and body.

Other symptoms were dry mouth with frequent thirst for small quantity of water. Loss of appetite, pain in lower legs, feet, arms, whole body hot but feet, hands, fingers and wrist part cold. Shivering, pain in right side of chest and back, abdomen. Bursting pain in forehead and restlessness.
on 20th, in CBC test, urine test and Typhoid 1gm test following were the obsevation:
HB = 9.9
Platelets= 1.6
Red Blood Cell= 4.16
Typhoid = W. Positive

Know fever is controlled but not cured. Thirst is same, no appetite, also vomitting occured at night, lose motion and back pain is still continue.

Kindly advise appropriate medicine.
 
Rani9 8 years ago
I hope that you are aware that Crocin is just another analgesic like Tylenol and cannot possibly be used to treat your attack of Typhoid which you first noticed 6 days ago.

I am indeed very surprised that your doctor prescribed some drugs but failed to warn you of how very serious your present condition is and did not give you the obvious drug which is Ciprofloxacin 500 of which you must take 1 tablet twice daily.

Please treat your case on a SOS basis as you are obviously in a very serious condition and must take Cipro 500 immediately. You will have to take it for at least a week after you are OK.

Do not waste your time on Homeopathic remedies as there is none that can help you now.

Only Ciprofloxacin 500 will cure you.
 
Joe De Livera 8 years ago
Thanks for your reply. Typhoid cleared using a medicine 'Polypod'. However, Ciprofloxin 500 was given to me by ENT doctor for infection in my ears. Typhoid was appeared after that.
 
Rani9 8 years ago
homeopathic remedy Baptisea 200 also helped very much to lower the temperature however paracetamol failed to do so. So, thanks for Doctor Deshlok post who suggested Bapt.200 and Diet suggested by him also very useful for fast recovery.
 
Rani9 8 years ago
Restlessness and desire for small quantities of water leads to Arsenicum Album but total symptoms have to be considered. Arsenicum aggravation is normally 1-3 afternoons and after midnight.
 
maraheem 8 years ago
Polypod is not a listed drug and I presume that the same doctor who prescribed an analgesic for your Typhoid gave it to you.

The Cipro you were prescribed for your ear infection is also very strange as it is a drug that is far too potent to treat ear infections as the standard Penicillin would have also done so.

You obviously contracted Typhoid after your ear infection and you can consider yourself fortunate that you survived with Polypod as Polypod is not a drug accepted internationally.
 
Joe De Livera 8 years ago
Dr. Livera
thanks for information. But, at that time we were not in a situation to discuss it we followed what the doctor prescribed however, Polypod & Polypod O both were discontinued by a Govt. Dispensary Doctor when we consulted him.

Baptisea 200 worked very well to break the fever and Chellidonium Q & Nux. Vom. Q worked very well to relieve stomach problems after Fever followed by AlfaMalt Tonic that is still in use for recovery from weakness.

Any other suggestion will be accepted thankfully.
 
Rani9 8 years ago

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