(3) Complications. There are complications in approximately 30 percent of
the untreated cases, and these account for 75 percent of the deaths from typhoid fever.
During the third week, intestinal hemorrhage can occur with a resulting sudden drop in
temperature, sometimes a sudden rise in pulse rate, pallor, sweating, hypotension, and
abdominal pain. Other symptoms of less frequency include urinary retention,
myocarditis, pneumonia, nephritis, thrombophlebitis, psychosis, cholecystitis, spondylitis
(typhoid spine), and meningitis. Intestinal perforation, the most frequently fatal
complication, is most common during the third week in adult males. Sharp abdominal
pain occurs suddenly (usually in the right lower quadrant) with nausea, vomiting, fall in
temperature, rapid pulse, and muscle spasm.
(4) Prevention. Typhoid immunization should be provided for household
contacts of a typhoid carrier, for individuals traveling to endemic area, and during
epidemic outbreaks. The vaccine consists of 2 injections of 0.5 ml each,
subcutaneously, 4 weeks apart. Carriers of typhoid are not permitted to handle food.
(5) Treatment. Administer ampicillin in 4 equal doses per day, 1 dose every
6 hours for 14 days. Each dose is 25mg/kg. Another medication for typhoid fever is
chloramphenicol, 1 g, which is given every 6 hours orally or it may be given
intravenously until the fever disappears. After this, give chloramphenicol for 2 weeks at
0.5 g every 6 hours (for children, 50 mg/kg daily). If the infection is resistant to
ampicillin and chloramphenicol, the victim may respond to trimethoprim-sulfonamide
mixtures. The patient should have a high-calorie, low-residue diet, and his skin must
have care. It may be necessary to administer parenteral fluids in order to supplement
oral intake and maintain urine output. If the patient is severely toxic, administer
hydrocortisone, 100 mg intravenously every 8 hours.
Section II. TICK-BORNE DISEASES
Ticks are common in woods and fields through the United States. They are
divided into two groups: the hard ticks and the soft ticks. The hard tick has a hard
shield on its back, and its mouth parts can be seen from above (figure 1-1). The soft
tick does not have a hard shield on its back, and its mouth parts cannot be seen from
above (figure 1-2). Ticks often have a leather-like appearance and are persistent blood
suckers. They cannot be dislodged easily while they are feeding and transmitting
harmful bacteria, viruses, and so forth. Ticks can remain submerged in water for long
periods, and they are relatively free from natural enemies but have wide range of hosts to
feed upon. They have been known to live fourteen years or more and are able to pass
infection from one generation to another. The female can lay as many as 18,000 eggs.
The four stages which a tick passes through are the egg, larva, nymph, and adult.
Unfortunately, the bite is not always felt, and the victim is subject to an encephalitis
virus, hemorrhagic fever virus, Colorado tick fever virus, or Rocky Mountain spotted
fever virus, which the tick can transmit through the bite.