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CHAPTER ONE
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1.0 Introduction
Typhoid/Paratyphoid remains a serious health problem many region of the world, with some 16-33million case and 500,000-600,000 death occurring annually (WHO, 2011). The disease is a major challenge and on essential health setback in some continents such as Asia and Africa particularly in Nigeria owing to poor hygienic environment and the absence of or insignificant clean water supply (Anita, et.al., 2002).
They are among the major prevalent disease in Nigeria due to various interconnected factors such as scarce amenities for handling unwanted products and abuse of antibiotic, these among other factors are responsible for the wide spread of typhoid/paratyphoid fever affecting both children any adult (Akinyemi et al., 2015).
They are vastly disseminated systemic disease commonly known as enteric fever. In most endemic area, approximately 90% of the enteric fever cases are actually typhoid/paratyphoid caused by Salmonella enteric server typhi and paratyphi (Parry, 2012). Typhoid fever is a contagious infection of the intestines that affects the whole body.
Symptoms may vary from mild to severe and usually begin six to thirty days after exposure (Anna, 2014). Paratyphoid fever shows similar symptoms but tends to be milder and the case fatality rate is much lower (Wain et. al., 2015).
These bacterial organism to the family, enterbacteriaceae (Crump et al., 2004). Salmonella consist of facultative anaerobes does not posses capsule, non-encapsulated, is a non-spore forming. Gram-negative bacillus most strains are petriclirously flagellated and hence motile (Bhan et al., 2005).
Among the over 2500 Salmonella serotype recognized to date (Poppoff, 2014) about 1400 infected humans and other warm blooded vertebrate, which are classified into Salmonella subgroup 1 now often referred to as Salmonella enteric subspecies enteric (Reeves, et al., 2010).
Although most of these salmonella serotype cause self limiting gastero enteritis in human, four causes typhoid fever, including Salmonella typhi and Salmonella paratyphi A, B and C (Parry, 2012). Salmonella paratyphi C is a member of serogroup, C, it is similar to salmonella typhi including the possession of a large pathogencity island, with gene coding for the V, (virulence) antigen and other genes potentially associated with virulence (Liu et. al., 2015).
Enteric fever has a combination of characteristic is that make it an effective pathogen. The species contain an endotoxin typical of gram negative organisms. It also produces and excrete a protein known as invasion that allow non phagocytic cell to take up the bacterium, where it is able to live intracellular. It is also able to inhibit the oxidation burst of leukocyte, making innate immune response in effective (Carol, 2012).
The disease is characterized by malaise, fever, abdominal discomfort, transient rash, splenomegaly, heptomegaly, bradycardia and leucopenia, the most prominent major complications are intestinal hemorrahage and perforation. The bacterium spread through poor hygiene habits and public sanitation condition and sometime also by flying insect feeding on feaces. Some of the carriers may be out working as food handlers, processor in food industries, water who takes care of daily feeding (Luby et al.,20l4).
Typhoid’ paratyphoid germ are passed in feaces and urine of infected people. Infection of people occur following ingestion of food or drinking, beverages that have been handled by a person infected or by drinking water that has been contaminated by sewage containing the bacteria. Once the bacteria enter the persons body, on reading the gut, the bacilli attach themselves to the micro villi of the focal mucosa by means of adhesion on the bacterial surface, which adhere specifically to mannose containing receptors on the epithelium.
They then penetrate to the lamina propria and submucosa where they are phagocytosed by neltrophits and macrophages. They resist intracellular killing and multiply within these cell (Arora, 2012).
Even after recovery from typhoid and paratyphoid, a small number of individual (Called carriers) continue to carry the bacteria. These people are consider a source of infection for other like ‘typhoid mary mallon’ who was a food people, killing 5 (WHO, 2011).
The transmission of these disease in most industrialized countries may be due to contaminated food or water. In some countries shell fish which was taken from sewage contaminated beds is an important route of infection. Where water quality is high and chlorinated water piped, into the house is widely available, transmission is more likely occur by food contaminated by carriers handling food. Infection through contaminated surgical equipment in hospital has also been reported (WHO, 2011).
Hospital environment is heavily laden with wide variety of pathogen. These may be present in air, dust, antiseptic lotions, water, food or may spread from shielding of the patient (Arora, 2012). In endemic area, identified risk factors for the disease include eating food prepared outside the home (e.g. ice cream, flavoured iced drinks) by street vendors (Luby et al., 2014).
Infection of asymptomatic pregnant women with salmonella occur as frequently as its infection in the general populace, with a prevalence of 0.2% positive rectal culture at the point of delivery (Gyang and saunder, 2008). It has been projected that the incidence of foetal loss which occur from untreated typhoid/paratyphoid case all through pregnancy might be as high as 80%.
Special concern arise as soon as pregnancy is complicated by Salmonella typhi and paratyphoid. Diverse serene outcome and morbidity connected with typhoid’paratyphoid fever in pregnancy include maternal mortality, premature labor, spontaneous abortion and infection of the fetus (Suleiman and sarwan., 2007).
Due to the hormonal change that suppress immunity pregnant women are’ at increased risk for getting food-borne infection (Smith, 2010). Hormonal change which occur during pregnancy impair the cell medicated immune response arid they increase the susceptibility of pregnant women to various infection. Pregnancy is considered as a high risk factor for acquisition of salmonella infection (Peject-Karapetrovic et al., 2007).
The widal agglutination test, developed by F widal in 1896 has been in use for more than a century as an aid in the diagnosis of typhoid fever. The main principle of widal test is that if homologons antibody is present in the reagent serum, it will react with respective antigen in the reagent and give visible clumping on the test card and agglutination in the tube.
The antigen used in the test ‘H’ antigen of salmonella paratyphi. The paratyphoid O’ antigen are not employ as they cross react with typhoid ‘O’ antigen due to the sharing of factor 12 ‘O’ antigen is a somatic antigen and ‘H’ antigen is flagellar antigen (Clegg et al, 2001).
1.1 Statement of Research Problems
Typhoid|paratyphoid remains a major public health problem is the developing world with very poor estimates of the number of case of deaths annually and information across sub-Sahara African is very scarce and the issue clearly require urgent and rapid action particular Africa including Nigeria which seems to have a high burden of enteric fever.
Laboratory diagnosis of enter fever require the diagnosis and identification of salmonella enteric in many area where the disease is endemic, laboratory capacity is limited.
1.2 Justification of Study
The source of water can very widely the personal hygiene of the manufacture may be questionable and also the motive of the manufacture which is most cases is profits making is also worrisome therefore, finding of this study will be beneficial to health policy makers in mapping out strategies to improve management and prevention of typhoid/paratyphoid case out break.
1.3 Aim and Objectives
To determine the baseline antibody titre to Salmonella typhi and paratyphi among asymptomatic pregnant women.
1.4 Objective
To determine the titre of Salmonella typhi among asymptomatic pregnant women.
To determine the titre of Salmonella paratyphi among asymptomatic pregnant
To determine possible association between some demographic and risk factors associated with acquisitions of the disease.
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