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Dr Ayobami Alabi, a consultant paediatrician at the Ladoke Akintola University of Technology Teaching Hospital, says in this interview with SADE OGUNTOLA, that stress does not cause typhoid fever, nor does malaria progress to become typhoid fever without exposure to the germs that cause it.

How prevalent is typhoid fever in our society, and which groups of people are mostly affected?

Generally, typhoid fever is a form of blood infection. It is a life-threatening infection caused by the bacterium Salmonella typhi that is usually spread through contaminated food or water and is still prevalent in our community. It is typically contracted through tainted food or water. Salmonella typhi bacteria proliferate and enter the bloodstream after being consumed. According to the World Health Organisation, as of 2023, typhoid fever was reported to be the cause of up to 110,000 fatalities globally each year. However, the cases are more common in Africa and Asia, particularly children and young adults. Most of the time, it occurs in children aged five to nine years.

It’s typical for people to claim that they received a diagnosis of both illnesses. Is there a connection between malaria and typhoid fever?

Well, this assumption is false. It is feasible for a person to have both infections going on at the same time. Nonetheless, distinct organisms cause typhoid and malaria. Salmonella typhi is the bacteria that causes typhoid fever, whereas Plasmodium falciparum is the main malaria parasite in our environment. The misconception is that many people believe that malaria can transform into typhoid fever if it is not treated appropriately. It is false. Typhoid fever is not created or evolved from malaria. Malaria can coexist with typhoid fever in a sick person. Naturally, fever is more than just that malaria or typhoid fever. There are many things that can cause fever, and infections are no exception.

Under what conditions can typhoid fever coexist with malaria in our own community?

Malaria is prevalent in Nigeria; in fact, the country falls into the malaria endemic region. Urbanisation, climate change, inadequate sanitation and personal hygiene, a lack of access to safe water, and rising antibiotic resistance are among the common variables that contribute to the spread of typhoid fever. It is therefore possible for someone to contract malaria from a female anopheles mosquito bite and contract typhoid fever from contaminated food or water with Salmonella Typhi bacteria. However, a weakened immune system due to any cause, inherited or acquired, can leave a person vulnerable to almost any infection, including typhoid fever.

Is the widal test still the preferred investigation in the management of typhoid fever?

The widal test used to be a popular test for management of typhoid fever. But science keeps evolving, and scientific evidence has demonstrated that it is not a reliable test for the diagnosis of typhoid fever. It might serve as a guide, but there is insufficient data supporting it as a tool to diagnose typhoid fever. Indeed, if a widal test is performed, a single test sample will not be sufficient to draw inference. A sustained rising titre will provide proof of an infection within the body system. However, as of right now, it is not advised for the diagnosis of typhoid fever. The organisms must be isolated from bodily fluids, such as blood, urine, and faeces, in order to diagnose typhoid fever.

Therefore, it is incorrect for medical professionals to diagnose typhoid fever in patients after requesting widal testing from those who have a fever. The test is not very sensitive, nor is it reliable. So it’s really not necessary.

What is the connection between water, sanitation, and hygiene (WASH) and the transmission of germs that causes typhoid fever in Nigeria?

Poor access to safe water, sanitation, and hygiene are things that make Typhoid fever prevalent in the environment. In many Nigerian communities, there is no access to drinking water, and personal and toilet cleanliness are not maintained. These variables are relevant because the typhoid fever-causing organism is transmitted through the faecal-oral route, which is when an infected person’s faeces are consumed through food or contact with the hands of another person. And from there, it begins to contaminate the different components of the body system; it gets into the blood, intestines, lymph nodes, and so on.

As a result, the issue is more severe in underdeveloped nations due to inadequate hygiene, sanitation, and access to clean water. Therefore, if there is insufficient access to drinkable water, people of all ages and socioeconomic classes—including infants—may be impacted. Nigeria cannot completely eradicate typhoid fever until we solve WASH issues.

In your opinion, how has open defecation, a common phenomenon in Nigeria, contributed to the problem of typhoid fever?

Open defecation is a highly prevalent practice in our community because many Nigerians lack access to toilet facilities. They excrete in the open and clean up with tissue paper and leaves. Naturally, they carry out their regular tasks—such as selling food and handling surfaces—without cleaning their hands with soap and water, which spread various bacteria.

It is an issue that is closely linked to the typhoid fever’s spread. In actuality, we discuss the spread of the disease through four entities whose names begin with the letter F: faeces, flies, fingers, and fomite, which is any inanimate object that might spread the disease to a new host when contaminated with or exposed to infectious substances. As a result, the Salmonella typhi bacteria can be easily transmitted to other individuals by an infected person or a carrier, either directly or indirectly.

So is it safe to eat foods from restaurants, cafeterias, or roadside buka to avoid contracting the germs that cause typhoid fever?

Particularly, in a low-middle-income country, we have a high patronage of cafeterias or roadside buka. If a person carrying the typhoid fever-causing bacterium is not practicing excellent hygiene, particularly when it comes to using the toilet, you can only increase the volume of individuals who will come to buy meals for them in a given day. Based on the location and size of cafeterias or roadside bukas, consider how many people the food vendor has managed to infect in a single day. In fact, it is advised that before becoming food vendors, people should be tested for the typhoid fever-causing bacteria. But the government must fully enforce this. Additionally, buying fruit off the street and not thoroughly cleaning it before eating it is not a good idea since it may contain various disease-causing germs.

What are the common symptoms of typhoid fever?

Its diagnosis requires expertise because it has some signs and symptoms that are common to other infectious diseases. That’s why there’s a mistaken belief that typhoid fever and malaria can switch roles and induce elevated body temperatures. On the other hand, typhoid fever symptoms include a persistent fever, abdominal pain, diarrhoea or constipation., headache, and nausea.

Some individuals may have a rash and altered unconsciousness. Severe cases may lead to serious complications or even death. In contrast to the intermittent nature of malarial fever, typhoid fever is typically marked by a stepladder fever that can last up to three weeks.

As the disease progresses, the person is growing weaker, unable to eat, and preferring to lie down. You can be certain that trouble is approaching. Typhoid symptoms also have the potential to impact any system in the body. The patient may experience signs of heart disease, lethargy, joint discomfort, headaches, altered sleep patterns, and bleeding from the anus.

What are the risk factors for typhoid fever in Nigeria?

WASH-related infections are the most common cause of typhoid fever, particularly in areas with high densities of IDP camp residents and crowded hostels. Additionally, an individual relocating from an area where typhoid fever is endemic to one where it is not constitutes a risk factor wherever he goes. Then, insufficient vaccine coverage or immunisation rates may be an issue. Evidence is also pointing to the role that urbanisation and climate change play in the typhoid fever epidemic. Everywhere we look, there is inundation from water. Imagine a river that flows from a high hill to a plain, carrying with it all of the debris. This is becoming an important risk factor that cannot be ignored in this era.

What’s the prevalence of typhoid fever in Nigeria?

Due to our inadequate data system, I am unable to provide a specific number about the incidence of typhoid fever in Nigeria. Nonetheless, varying hospital-based research across the nation reports varying percentages, between 5 and 7 percent. Typhoid fever incidence is not only based on gender or occupation. However, when it comes to infectious diseases, girls are typically somewhat more protected than boys. It is hypothesised that due to their genetic composition, girls are less vulnerable than boys.

How successful are antibiotics in treating typhoid fever, especially in light of the fact that many bacteria are becoming more resistant to various forms of antibiotics?

Typhoid fever still responds to antibiotics, although resistance of many germs to different types of antibiotics is increasing. Studies by experts have documented typhoid fever resistance to some common antibiotics. Antibiotics are abused because they are marketed as over-the-counter medications. Inappropriate use of them is another issue. People, for example, mix antibiotics with malaria medication in hopes of treating malaria more quickly. All of these are contributing to the development of resistance to traditional antibiotics and complicating the management of typhoid fever.

How true is the claim that stress causes typhoid fever?

What most people tag stress has different interpretations. When somebody has not slept well in the previous two days or is overworked, he says that he is stressed. But the claim that stress causes typhoid fever is not true. Stress by itself does not directly cause infectious diseases like typhoid fever. Typhoid fever is caused by Salmonella typhi bacteria, which is primarily transmitted through contaminated food or water and not by psychological factors like stress.

However, stress might indirectly make someone more susceptible to infections in general by weakening the immune system. Prolonged stress can weaken the immune system, making it less effective at fighting off illnesses. If a person is exposed to Salmonella typhi when debilitated, they may be more susceptible to acquiring typhoid fever.

Common misconceptions and myths people say about typhoid fever

Common misconceptions and myths about typhoid fever include that malaria can metamorphose or progress to typhoid fever; typhoid fever is caused by cold weather or getting wet; stress causes typhoid fever; only poor hygiene and sanitation can cause typhoid; and once you’ve had typhoid fever, you can’t get it again.

Others are typhoid fever is only a problem in developing countries, typhoid can be fully prevented by vaccination, drinking only bottled water ensures typhoid prevention, typhoid carriers show symptoms and are always sick, typhoid is always a deadly disease, and typhoid fever is the same as typhus.

Cold weather can make people more prone to infection by weakening their immune systems, but it does not cause typhoid. Although they sound similar, typhoid and typhus are distinct diseases. They are caused by various bacteria, which are unrelated despite their similar names.

While poor sanitation and hygiene raise the risk of typhoid, anyone who consumes contaminated food or water can develop the disease, regardless of personal cleanliness or socioeconomic position. Even in modern environments, faulty food management can cause outbreaks.

Having typhoid once does not guarantee lifetime immunity. Typhoid fever can be contracted more than once if exposed to the bacterium again, especially in locations where the disease is prevalent.

Although typhoid vaccines are available and provide protection, they are not completely effective. Vaccination lowers the danger but does not eradicate it. Typhoid prevention also includes good hygiene habits, clean drinking water, and adequate food preparation methods.

Drinking bottled or filtered water is a vital step in preventing typhoid in locations where it is common; however, other sources of infection, such as food or poor hygiene, are also a concern. Typhoid fever is curable and has a low death rate when treated promptly and properly. Without treatment, complications can emerge, which can be fatal, but early detection and antibiotic therapy usually result in complete recovery.

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