Diarrhoea vs Enteric (Thypoid) Fever

Enteric or typhoid fever has recently been in the spotlight with a perceived increase in cases although there are annually cases diagnosed. Although enteric fever can be serious and is medically treated, it can often be mistaken for Diarrhoea and Gastroenteritis that is fairly common during the warm summer months.

Seasonal Diarrhoea can often be mistaken for Enteric fever due to the similar symptoms and similar ways in which these illnesses are transferred. The big difference between enteric fever and diarrhoea is that the latter is usually caused by viruses and enteric fever by a bacteria called Salmonella Typhi. Dr Jaco Murray, Head of Paediatrics at Paarl hospital says the two conditions can be distinguished according to the symptoms displayed. “Typhoid fever can be seen as a severe type of diarrhoea, where you get other symptoms not usually associated with normal viral diarrhoea, he explains.

What is Diarrhoea?

Diarrhoea is when a child has a runny tummy or frequent loose stools.  Often the child may be nauseous and can vomit too.  Diarrhoea is usually caused by viruses.  If the child loses too much water she/he can become very ill and may die.  It can also occur amongst adults, although the effect of diarrhoea is less severe for adults.

During the warm summer months, diarrhoea can be quite common amongst babies and young children.  According to Dr Murray diarrhoea is more common in the summer months and the department of Health monitor the Peadiatric Surge Season from November to May. 

What is Enteric Fever?

Enteric Fever (typhoid or paratyphoid fever) is caused by a bacterium called Salmonella Typhi and Salmonella Paratyphi A,B or C.

• It is most common in areas where water and food may be unsafe and where sanitation is poor.
• Any person who ingests the organism is at risk of developing Enteric Fever.
• Diarrhoea can also be a symptom of enteric fever.

What are the symptoms of Diarrhoea?

The patient has a runny tummy or loose stools, vomits and presents with fast breathing.

Fast breathing is a key symptom of pneumonia and diarrhoea. Chest in-drawing is also serious. Don’t wait: get the child to the clinic.

• Other danger signs are: child can’t drink; vomits up everything; child has fits, is weak and stares blankly; there is blood in the stools.
• When there are danger signs then take the child to the clinic as soon as possible.

What are the symptoms of Enteric Fever?

If you have Enteric Fever you may have mild or severe symptoms, which include:

• Fever
• Headache
• Feeling unwell in general
• Abdominal pain or cramps
• Nausea and vomiting
• Constipation or diarrhoea
• A rash on the abdomen (stomach)
• Dysentery (blood in the stool)
• Dry cough

The symptoms may appear as early as 3 days to as late as 60 days after you were exposed to the bacteria. You usually start to get sick within 9 to 21 days after exposure. If you experience symptoms, seek health care immediately.

How is Diarrhoea treated?

Make sure that everyone who looks after the child knows how to make the sugar salt drink to treat diarrhoea. Give small amounts of the drink frequently. (Mix one litre clean water + 8 teaspoons sugar + half a teaspoon salt).

• A very sick child may need extra medication and oxygen and may be hospitalised.
• Continue feeding the child small amounts at a time.
• Continue giving breast milk even if baby has diarrhoea and vomiting.
• A child who has been sick can only eat a little food at a time. Offer food more often (every 2/3 hours at least 5 times a day).

How is Enteric Fever diagnosed and treated?

A healthcare worker will collect and send samples of your blood or stool (faeces) to a laboratory for testing.

• Enteric Fever is treated with antibiotics.
• Antibiotic treatment is also used to treat carriers.
• If you become very sick, you may need to be hospitalised.

How can Diarrhoea and Enteric Fever be prevented?

1. Proper hand-hygiene which includes thorough washing of hands with water and soap after using the bathroom/toilette, and before preparing or eating a meal.
2. Maintain good hygiene in the kitchen when you are handling and preparing a meal. Cover food to keep flies away.
3. Make sure that water is safe to drink. If unsure, then boil it. Store water in a container that has a tap/spigot. If not available, use a clean bucket with a lid.
4. Household water and sanitation supplies should be safe. Avoid water that may be contaminated (polluted) with sewage. 
5. Safe disposal of human stools/poo and nappies.
6. Children should be given the rotavirus vaccine at 6 weeks and 14 weeks. This protects against the main form of diarrhoea.