Typhoid: Sings And Dietary Management
Typhoid is an infectious with an acute fever of short duration and occurs only in humans. Salmonella typhi causes typhoid , Schottmulleri causes paratyphoid B. Faeces and urine of the patients or carriers of the disease are the source of infection. Drinking water or milk and food contaminated by intestinal contents of the patient or carrier or by flies which often transmit the disease.
Typhoid bacilli do not multiply in water but some may survive for about 7 days. They mat survive for over a month in ice and ice cream. Typhoid bacilli grow rapidly in milk without altering its taste or appearance. Vegetables grown in sewage farms or washed in contaminated water are a positive health hazard.
Incubation period is usually 10 to 14 days. But it may be as short as three days or as long as three weeks depending upon the dose of the bacilli ingested.
The disease begins in small intestine, where the bacteria attach to the epithelium of intestinal wall, penetrate this layer, multiply in the mesentric lymphnodes and eventually reach the blood stream. Here lysis of the bacteria by the action of antibodies and complement results in the liberation of endotoxin which causes generalised symptoms such as fever. Some bacteria pass from liver to the gall bladder and bile ducts and are secreted into the intestine where they establish a secondary infection and may cause diarrhea. Bacterial excretion may occur for weeks and some persons may become chronic carriers.
Symptoms And Signs
The disease is characterized by a continued, high inflammation of the intestine, formation of intestinal ulcers, haemorrhage and enlargement of spleen can occur, Peyer’s patches of flat patches of lymphatic tissue situated in the small intestine but mainly in the ileum are the seat of infection in the typhoid fever. The patient may complain for diarrhea or constipation and severe stomach ache. Abdominal absorption of nutrients is decreased and the patient may feel headache and anorexia.
Principle Of Diet
A high calorie, high protein, high carbohydrate, low fat, high fluid, low fiber and bland diet is suggested for typhoid patients.
The general principles of dietary treatment of fever is followed for typhoid also.
At first clear fluid diet is given followed by full fluid and soft diet is suggested. On liquid diets of the patient may not meet high calorie and high protein requirements. As the patient is improving soft diet can be given. The febrile period may upset water balance and liquid diets are helpful in meeting water and electrolyte requirements.
Foods To Be Included:
Fruit juices with glucose, coconut water, barley water, milk, milk shakes if there is no diarrhoea, custards, thin dhal, curries, eggs, baked fish, minced meat, curd, cottage cheese, cereals, gruels, steamed vegetable juices, milk puddings, vegetable puree.
Foods To Be Avoided:
Butter, ghee, vegetable oil, no irritating fiber foods, chillies and other spices, rich pastries, fried foods, puddings and cream soups.
Because of the intestinal inflammation, great care must be exercised to eliminate all irritating fibers and spices in the diet. Refined cereals, bread, egg, boiled potato simple deserts like custards, porridges can be given.
Adequate nutrition reduces convalescence period.