HEALTH · MEDWED with Mimi.

MEDWED WITH MIMI: WHY ‘MALARIA AND TYPHOID’ IS NOT YOUR DIAGNOSIS.

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So, my roommate walks into the room after been gone for a while to her family clinic. “I am going for blood test,” she said. “I have been feeling very weak these days with recurrent headaches that I do not  understand”. For the 3rd time in the same year, she was diagnosed with “malaria and typhoid”.

She returned with a plastic bag from the pharmacy containing antimalarial tablets, antibiotics and, lest I forget, “blood tonic”! I had gotten tired of trying to explain to her that typhoid did not automatically affect one along with malaria. The parasite must be ingested feaco-orally. So I watched as she gulped the numerous tablets down her throat. Hopefully one day, she would discover the truth in what I had been saying. Most people out there are like my roommate. Popping packets and packets of pills in an attempt to treat a disease they most likely do not have.

Malaria and typhoid are two different diseases. They are most often misdiagnosed due to a number of factors with wrong diagnostic techniques topping the list. When it is possible to distinguish between the two diseases without even carrying out a test because they present with different signs and symptoms. Now who’s really to blame, the physicians for wrong diagnoses made or the patients for their unquenchable thirst for drugs? It’s hard to tell. 

Here are six differences between malaria and typhoid worthy of note for both care givers and receivers.

1). Causative organism : Typhoid fever is caused by a bacterium known as Salmonella typhi, which grows in the blood and intestines. It is found commonly in areas with poor sanitation and hygiene whereas malaria is caused by a protozoa known as Plasmodium. There are four species viz P. falciparum, P. vivax, P. ovale and P.malariae. P.falciparum is the most common cause of severe and complicated malaria.

2). Difference in Transmission: The transmission of malaria is from the bite from an infected female anopheles mosquito. Breeding sites for mosquitoes include stagnant water, bushes, refuse dumps etc. On the other hand, typhoid is spread by eating or drinking food or water contaminated with the faeces of an infected person. Risk factors include poor sanitation and hygiene. Therefore, it is safe to infer that for an individual to come down with typhoid, it most likely would have also affected a number of people in the same environment because they probably have the same water and food source.

3). Difference in Symptoms: While malaria symptoms are milder in non severe forms, typhoid is more aggressive and differs depending on the stage of the disease. Symptoms of malaria include;
– nausea
– vomiting
– chills
– fever
And sometimes;
– diarrhoea

There are four main stages of typhoid. Within the first 7 days which is the first stage, patient can suffer from;
– high grade fever
– abdominal pain
– bleeding from nose
– bradycardia (reduced heart rate)
– cough and
– tiredness.

In the second stage;
– fever
– reduced heart rate
– diarrhoea or constipation
– confusional state
– rose spots on trunk

Then in the third stage, patient may have some complications and the last stage is the stage of recovery.

4). Difference in Complications: For typhoid, the patient may experience peritonitis, gut bleeding, endocarditis, agitation,  and encephalitis. But the complications of malaria include renal impairment, retinopathy, cerebral malaria, convulsions, coma and death.

5). Difference in Diagnostic Tests: Diagnosis of typhoid is made by either cultures (blood, bone marrow or stool) or by the Widal test.Tests to confirm malaria include Full blood count , Malarial Parasite test and Rapid diagnostic tests (RDTs) based upon the microscopic evaluation of causative agent.

6). Difference in Treatment: Anti-malarial drugs include amodiaquine, lumefantrine, mefloquine or sulfadoxine/ pyrimethamine but for typhoid treatment, antibiotics such as ciprofloxacin and olfloxacin are commonly prescribed.

WHY THEN IS TYPHOID USUALLY DIAGNOSED WITH MALARIA?
The widal test which is the test carried out in most laboratories is a serological test for Salmonella typhi and S. Paratyphi. It demonstrates salmonella antibodies against the Salmonella antigens(O-somatic and H-flagellar) in the blood. In a study conducted in Benue state by Mbuh et al, most patients who had positive Widal test results did not show any organism after the culture was done. They were said to have been possible cases of cross reactivity between S. Typhi and malaria parasite antigen. It was then inferred that the outcome of the Widal reaction for patients with a clinical suspicion of typhoid and malaria depends on the individuals host response which become stimulated in febrile conditions associated with malaria fever. Therefore for a proper diagnosis of typhoid to be made, a blood, bone marrow or stool culture must be carried out .

WHAT DO I STAND TO LOSE IF I TREAT FOR BOTH MALARIA AND TYPHOID WITHOUT PROPER DIAGNOSIS?
 
You may lose nothing but gain “drug resistance”. Drug resistance is the reduction in effectiveness of a drug in curing a disease. Repeated and improper use of antibiotics are primary causes of the increase in drug resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed but some resistant ones may be left to grow and multiply.

Researchers have previously proven that in countries where patients pay for the consultations like Nigeria, the medical practitioners are more sensitive to the patient’s expectations and it is more challenging for them not to prescribe the antibiotics since the patient in most cases believes that he/she will need the antibiotics for a quick recovery. The danger of this however, is that if a microbe such as Plasmodium or even Salmonella is resistant to many drugs, treating the infections that it causes can become very difficult or even impossible. Someone with an infection that is resistant to a certain medicine can pass that resistant infection to another person. What happens when drugs can no longer treat diseases? They eventually overwhelm the body and lead to death.

Apart from the dangers of drug resistance, every drug contains toxins which should not be exposed to the body unduly. While typhoid still affects a considerable percentage of population, it is still not as common as it is diagnosed to be. With increased awareness, effective control measures, better hygiene and sanitation practises, both malaria and typhoid could be history.

Therefore remember, the next time you are going to have yourself checked for malaria or typhoid, ensure to demand for proper screening and diagnostic techniques before drugs. Till next time, keep calm and stay healthy!

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