What are the difference between typhoid, typhus and parathyroid fevers?

Q. I recently read that Oliver Cromwell, the English Civil War leader in the 17th century, actually died of typhoid and malaria. He wasn't poisoned like some historians believed. This scares me because we recently had a typhoid outbreak in KL. Is typhoid really so dangerous?

A. It can be without treatment. Typhoid fever can lead to a lot of complications. The most serious one of these is gastrointestinal bleeding and perforation of the walls of your intestine. This can develop in the third week of the disease.

A perforation means that a hole or opening appears in the wall. In this case, it is the wall of your gut, causing intestinal contents to leak out into the abdomen and result in all kinds of infections and inflammation.

It can even lead to sepsis in the blood and ultimately kill you.

But we are not in Oliver Cromwell times. There is a ready treatment for typhoid today.

Typhoid fever can lead to other less common complications which can also be quite dangerous.

These include myocarditis (inflammation of the heart muscles), endocarditis (inflammation of the heart and valve linings), pneumonia (inflammation of the lungs), pancreatitis (inflammation of the pancreas), infections of the kidney and bladder as well as delirium, hallucinations and psychosis.

What is typhoid caused by? I heard it's due to unsanitary food and water.

It's actually caused by what is in the unsanitary food and water. Typhoid is caused by the Salmonella typhi bacteria.

It spreads through contaminated food or water, or even if you have close contact with someone who is infected. It is passed through the faeces and urine of infected people.

So if someone who is infected is cooking your food and hasn't washed his hands properly, the bacteria can be passed on.

Even after they are treated, some people who have recovered continue to harbour Salmonella typhi in their guts or gallbladders, sometimes for years. These people can still go around spreading typhoid without knowing it.

How will I know if I have typhoid?

About one to three weeks after contracting the bacteria from someone, you may experience a fever that can reach as high as 40.5°Celsius, headache, weakness and muscle aches, fatigue, loss of appetite and weight, dry cough, abdominal pain and diarrhoea or constipation.

If you don't get any treatment, you may become delirious and lie unmoving and exhausted with your eyes half-closed. This is known as the typhoid state.

I have heard of this fever - typhus. What is the difference between typhoid and typhus?

Typhus fever is caused by a different sort of bacteria, called rickettsiae. It is transmitted by fleas, mites or ticks. When these insects bite you, they leave the bacteria behind in your skin.

You scratch your skin, and your skin then opens, leaving the bacteria to enter your bloodstream.

It can be hard to differentiate typhus symptoms from those of typhoid. Typhus presents with high fever and chills, a headache and rash. It is best to quickly go to a doctor to get diagnosed.

What is the difference between typhoid fever and paratyphoid fever? Why do they all sound so alike?

Even doctors find them difficult to distinguish! The diagnosis is mostly done in the lab when cultures of your blood, faeces or urine are taken and tested.

Paratyphoid fever is very similar to typhoid fever, but is a lot milder. It is caused by the Salmonella paratyphi bacteria. Both the typhoid and paratyphoid fevers are called enteric fevers (enteric means gut) - they are gut infections.

Paratyphoid fever is transmitted in the same way as typhoid fever.

So the difference between this and typhoid is that you get the disease quicker, it tends to be milder, and it's over sooner than it takes for typhoid to be resolved.

All three fevers - typhoid, paratyphoid and typhus - are treated by antibiotics.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.