The comical Typhoid Mary also known as Mutant Zero, is a fictional supervillain who is an enemy of Daredevil and Spiderman. This name was derived from the real historical Typhoid Mary of Mary Mallon, who infected 51 people with typhoid and killing three of them with the killer bacteria that she carried along with her while serving as a cook.
Mary Mallon was born in Ireland in 1869. Fourteen years later, she migrated to the United States and later found work as a cook for seven affluent families in New York City. She first worked in Mamaroneck, New York, in 1900 where, within two weeks of her employment, the residents developed typhoid fever. A year later, she moved to Manhattan, where members of the family for whom she worked with, developed fever and diarrhea. Worst of all, the laundress of the family died. Mallon then moved on to work for a lawyer and left after seven of the eight people in that household became ill.
Back to Cambodia, just about 2 months ago, a young Malaysian girl in her twenties came to me, saying that she had been having “stomach ache” and high fever at night for one month. Further enquiry revealed that she also had episodes of diarrhoea and constipation.
My suspicion of the possibility of infection with typhoid bacteria (Salmonella typhi) was confirmed with a blood test. She decided to return to Malaysia for treatment. Two weeks later, she wrote me a note to thank me for the prompt diagnosis. She also revealed that she was admitted for two weeks and at some point of time during the treatment period she had delirium, another known manifestation of the disease.
Just a week ago, I saw another local Cambodian woman here in Phnom Penh with inadequately treated typhoid. She had headache, persistent fever, chill at night, intermittent constipation and drastic loss of weight (6 kilograms over 3 weeks). Back in my country, Malaysia, the last patient that I remember seeing with typhoid was probably at least 15 years ago. The young 8 year-old boy presented with clinical signs and symptoms of appendicitis. He was referred to a surgeon who operated on him. The lab report later confirmed that he had typhoid infection of his appendix.
Typhoid fever is rare in developed countries. However, it remains a serious health threat in the developing world, especially for children.
The two cases of typhoid that I have seen within such a short period of time in Phnom Penh certainly reminded me that typhoid is endemic in Cambodia as I have read earlier in my review of endemic diseases in this country. Many cases could have been missed if this disease is not highlighted to the public. Thus, it is important for me to write about this, to promote public awareness about this debilitating or killer disease apart from raising the index of suspicion of typhoid among my fellow medical colleagues.
Let us be reminded that typhoid is here. It is perhaps quite common in this country. The classical manifestations usually include high fever, headache, abdominal pain, and either constipation or diarrhoea. Untreated sufferers ultimately become delirious or in more extreme cases, they may lie motionless and exhausted with eyes half-closed, a state that preempts the development of life-threatening complications.
Be on the lookout for this disease so that prompt diagnosis and treatment can be instituted. Hopefully the suffering of those infected can be minimised and the spread of the disease especially through eateries curtailed.
Typhoid fever spreads through contaminated food and water. It may also be spread through close contact with someone who is infected.
According to scientist Prof. Denise Monack, PhD, associate professor of immunology and microbiology, the typhoid causing bacteria is able to hide out in human immune cells by altering their metabolism to its benefit, much as someone might remodel a newly rented home to suit its own comfort, thus surviving in its carrier without causing any clinical problem. She estimated that between 1 to 6 percent of people infected with Salmonella typhi become chronic carriers without symptoms.
We may not be aware that some of the cooks and waitresses serving us at the eateries are ‘Typhoid Maries’. Thus, may I humbly suggest that typhoid vaccination be made mandatory for all food handlers in Cambodia for their safety and the safety of their customers – you and me. After all, the vaccination is cheap, effective for three years and easily available. For those who have phobia of needles, we have good news for them. The typhoid vaccine is also available in the form of pills, too. So, go for it.
Vaccinating of high-risk populations is the best way to control typhoid fever. Thus, in a typhoid endemic country like Cambodia, vaccination against the disease should be aggressively promoted. The World Health Organisation listed typhoid vaccination as one of the vaccinations recommended for travellers travelling to Cambodia.
Apart from the vaccination, the following preventive measures are recommended:
Wash your hands. Washing your hands frequently with soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Alternatively, one may want to apply a recently introduced innovative hand sanitiser that stays for 24 hours to combat bacteria and viruses. (Available at BH Clinic)
Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. Drinks without ice are recommended.
Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. You may want to eat raw foods that you prepared for yourself.
Avoid foods from street vendors. Steaming hot foods are recommended. It is best to avoid foods from street vendors, as they are more likely to be contaminated.
Typhoid fever infects roughly 21.6 million people (about 3.6 per 1,000 population) and kills an estimated 200,000 people every year.
My next column will be on ‘HIV infection in Cambodia’.
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via email [email protected]
Tel: 023900446 or Whatsapp: +60164122977