TYPHOID AND HOMEOPATHIC MANAGEMENT

                                                                  TYPHOID FEVER

Typhoid or enteric fever is the commonest bacterial infection and mainly caused by salmonella group of bacilli (s.typhi and s paratyphi).the clinical features are characterized by long continued fever.

 CAUSES AND TRANSMISSION:-

Typhoid fever is caused by salmonella type, a gram negative bacillus. The disease get transmitted by

-          Faeccus or stools of patients and already affected person.

-          Contamination of water, milk or other food materials.

-          House flies plays important role.

-          Contact with infected persons can also transmit the disease.

-          Poor maintains of sanitary arrangements.

INCUBATION PERIOD:

The incubation period of typhoid fever varied from 10-14 days.

PATHOLOGY:-

The organisms enter and multiply in the bloodstream producing general septicemia. Finally, they settle down in collections of lymphoid tissues in the small intestine known as the peyer’s patches. The classical lesion is an oval ulcer in the longitudinal axis of the intestine. Sloughing of the ulcer begins in the second week and the slough separates out by the third week. The ulcer assumes a sieve like appearance with rounded margins. Sloughing may cause perforation in the wall of the intestine. Haemorrhage may occur from the sloughed- out ulcers. Healing of the ulcers occurs in the fourth week. In carriers, the organisms settle down in the gall bladder and continue to be discharged in the faeces.

SYMPTOMS:-

The onset is insidious and in untreated case the disease runs a course of 4 weeks. Fever is the most characteristic feature though headache, malaise and a feeling of weakness may be present

-          Fever – fever raises gradually in evening but falls slightly the next morning. By the end of second week, the temperature reaches a definite peak level (usually 102 F – 104 F).

-          The tongue is heavily coated but the margins are clear.

-          Distension of abdomen and gurgling in the caecum.

-          Anorexia, nausea and abdominal discomfort.

-          Constipated followed by (‘pea-soup’) diarrhoea.

-          The typical rashes ‘rose-spots’ appear by the end of first week. There are small, round, raised spots mostly on the upper part of the abdomen and the chest.

-          The spleen is palpable and soft in consistency.

-          In severe infection – the patient becomes drowsy and mentally confused. He talks incoherently in a slow voice (muttering delirium), pulls up imaginary threads or picks up the bed clothes. He presents a vacant staring look and is unaware of the surroundings. This state is known as typhoid state or typhoid encephalopathy.

-          Haemorrhage and perforation may occur, usually after 14^th day of fever.

COMPLICATIONS:-

1.       Haemorrhage – it occurs during the second or the third week due to separation of slough in the peyer’s patches. If severe, the patient passes into shock.

2.       Perforation – it usually occurs in the third week. There is sudden acute pain in the abdomen and vomiting.

3.       Typhoid encephalopathy.

4.       Bronchopneumonia.

5.       Thrombophlebitis.

6.       Parotitis.

7.       Cholecystitis

8.       Osteomyelitis

9.       Arthritis, myositis

10.   Toxic myocarditis

INVESTIGATIONS:-

a.       Total and differential leukocyte count .

b.      Serological test – WIDAL TEST – the test depends on the presence of typhoid antibodies in the serum. Since antibodies take time to develop, the test is positive only after 10^th day. The serum of the patient is mixed with known typhoid bacilli. Agglutination occurs if the serum contains the specific antibodies. The typhoid bacillus has 2 type of antigens, one derived from the body (somatic or ‘O’ antigen) and the other derived from the flagella (flagellar or ‘H’ antigen).positive agglutination in rising titres of ‘O’ antigen (above 1;160)is diagnostics.

c.       Culture of bacilli.

DIET:

-          The diet should be bland and easily digestable.

-          Liquid items such as milk, horlicks or fruit juices.

-          Avoid meat, chicken etc.

-          Well cooked rice, sweetened rice, loaf crushed in milk  should give after patient  improves and temperature is settles down.

-          No solid items should be given till 3 days.

TREATMENT:-

-          Use highly antibiotics like ampicillin, amoxycilin, ciproflaxcin,

-          Cortisone is indicated in severe cases.

HOMEOPATHIC MANAGEMENT:-

1.       AGARICUS:-

      Empty eructation’s, tasting of apples. Flatulent distention of stomach and abdomen. Diarrhoea with much fetid flatus. Fetid stools. Very sensitive to cool air. Violent attacks of heat in evening. Copious sweat. Burning spots. Better; moving about slowly.

2.       APIS MELLIFICA:-

      Stupor, with sudden sharp cries and startings. Awkward; drops things readily. Sudden shrill, piercing screams. Vomiting of food. Craving for milk. [Rhus.]. Dropsy of abdomen. Involuntary on every motion; anus seems open. Diarrhoea watery, yellow; cholera infantum type. Haemorrhoids, with stinging pain, after confinement. Constipation; feels as if something would break on straining. Afternoon chill, with thirst; worse on motion and heat.

3.       BAPTISIA:-

     Claimed that it will, if given as soon as typhoid is suspected, cut the disease short, face is dark red, with a besotted expression, looking like one intoxicated. Stupid, dull, confusion of ideas goes to sleep while answering questions. Feels scattered about, must toss about in order to get himself together. Dull aching pain all over the body. Pulse is full and soft. The tongue is brown, blackish and dry. The breath is offensive; everything about the patient seems to be fetid, diarrhoea of dark fluid, exceedingly fetid. The king of all remedies for typhoid.

4.       BELLADONNA:-

      With marked cerebral symptoms. The face is flushed, the pupils dilated, the carotid pulsates. Intolerance of noise or light. Delirium early in the disease. Troublesome bronchial irritation and cough. Wants to strike, bite and kick.

5.       BRYONIA:-

     The face is red and swollen, the lips are dry, brown and cracked, the mouth is also dry, without thirst, or thirst for large quantities of water,  the tongue, at first, is coated white in middle, with clean edges, but later coating is in brown with dry tongue, dull, throbbing headache as if head would split, aggravated from least movements, constantly puts his hand to his head. Delirium day and night, wants to escape, wants to go home, talks of his business. Nausea and faintness on raising. Abdomen distended, and tender to touch. Constipation of little value after diarrhoea has set in.

6.       CARBO VEG:-

     Last stage, stage of collapse. Colloquative diarrhoea. Face Is pale, sunken, cold and Hippocratic, the breath is cold, the extremities are cold and may be covered with a cold sweat. Great prostration, the patient wants more air, wants to be fanned all the time, symptoms of heart failure.

7.       GELSEMIUM:-

     Stage of invasion, or during the first week of the fever. Sense of extreme prostration or tiredness, trembling from weakness, where the nervous symptoms are prominent. Soreness and bruised feeling over the body. The face is red and suffused, drowsy; the eyelids are heavily he cannot keep them open. Dull pain or a strange feeling, in the head, with jerking of the muscles. Pulse full and weak.

8.       LYCOPODIUM:-

     On about the 14^th day of the fully developed fever, when the rash belonging to the fully developed disease does not appear and the patient sinks into an unconscious state with muttering delirium, picking at the bed clothes, distended abdomen with great rumbling of flatus. Constipation, sudden jerking of the limbs here and there, involuntary urination or retention of the urine. 

9.       MURIATIC ACID:-

     Extreme prostration, with constant tendency to slide down in the bed. Unconscious, low muttering delirium. Stupid sleep, groans, lower jaw dropped. Tongue is shrunken, dry like leather, the tongue is almost paralyzed, can hardly speak, involuntary passages from bowels and bladder.

10.   RHUS TOXI:-

    Intestinal stage, after diarrhoea has set in, prostration, restless, disturbed anxious sleep with frightful dreams, pickling at the bed clothes. Face is dark and livid, the eyes are injected. The tongue is dry, red and smooth, red triangular tip. Worse after midnight. 

Some of other medicines for typhoid are arnica, ars alb, calc carb, colchicum, hamamellis, hyoscyamus, mercurius soul, nitric acid, acid phos, opium, pulsatilla, stramonium, terebinthina, zinc. Met.