Food-borne diseases usually come in many forms. From diarrhea, cholera and dysentery, we are wary of them all but few really give a hoot about typhoid fever.

Mary Mallon, better known as Typhoid Mary, was the first person in the US identified as an asymptomatic carrier of the pathogen associated with typhoid fever. She was presumed to have infected 51 people, three of whom died, over the course of her career as a cook. She was twice forcibly isolated by public health authorities and died after a total of nearly three decades in isolation.

According to Dr Florence Mutesi, a general practitioner at Rwanda Military Hospital, Kanombe, the disease is caused by eating food or drinking beverages that have been handled by a person who is shedding the bacteria or if the bacteria gets into water used for drinking or washing food. 

Typhoid fever is more common in areas where hand washing is less frequent and water is likely to be contaminated with sewage. 

Once the bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms. 

Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.

Persons with typhoid usually have a sustained fever as high as 39° to 40° C. They may also feel weak, or have stomach pains, headache, or loss of appetite. 

In some cases, patients have a rash of flat, rose-coloured spots. Persons who do not get treatment may continue to have fever for weeks or months, and as many as 20 per cent may die from complications of the infection

Dr Mutesi said typhoid fever is treated with antibiotics such as fluoroquinolones, ceftriaxone and azithromycin.

She said diagnosis can be a challenge sometimes because symptoms and signs of typhoid fever can resemble other diseases like malaria, disseminated TB, hepatitis and its early symptoms can be misdiagnosed to urinary tract infection or viral respiratory infection.

"With typhoid fever, the best precaution is practicing good hygiene because prevention is better than cure, Dr Mutesi said.

Justine Bagirisano, a registered midwife at Rwamagana School of Nursing and Midwifery, says people should put more emphasis on personal hygiene because that is the most important way to control typhoid fever.