Typhoid fever

Symptoms: Prolonged high fever, headache, nausea, stomach pain, diarrhoea, constipation, fatigue (extreme tiredness)

Causes: Salmonella Typhi bacteria, contaminated water or food, ice made from untreated water, unpasteurized milk or juice

Risk Factors: Close contact with a person having typhoid, travelling to endemic areas, poor hygiene habits, drinking contaminated water

Prevalence: 11-21 million cases worldwide each year. 4.5 million cases every year in India.

Severity: Mild to severe

Which doctor to consult: Internal Medicine Specialist, Infectious Disease Specialist, Paediatrician (in case of children)

Overview:                                                             

Typhoid fever, also known as enteric fever, is a serious bacterial infection caused by the Salmonella enterica serotype Typhi (Salmonella Typhi) strain. Once the bacteria are consumed, they multiply and enter the bloodstream.

Typhoid fever usually spreads through the consumption of contaminated food or water. Typhoid occurs mostly in association with poor sanitation and a scarcity of clean drinking water both in urban and rural areas.

The symptoms of typhoid fever are prolonged high fever, headache, nausea, stomach pain, diarrhoea, constipation, and fatigue (extreme tiredness). The vaccination can lower the risk of typhoid fever and is usually recommended if you are travelling to parts of the world where this condition is common.

Typhoid fever is treated with antibiotics. Most patients will feel better in a few days with prompt treatment and major side effects are quite rare.

Symptoms:

People with typhoid fever may experience the following symptoms:

• Prolonged high fever

• Headache

• Nausea

• Stomach pain

• Diarrhoea

• Constipation

• Fatigue (extreme tiredness)

• Rash, in some cases

Causes:

Typhoid fever is caused by Salmonella Typhi bacteria. It is usually spread through contaminated food or water. The infection spreads due to the following reasons:

• After using the restroom, an infected person's faeces and, less commonly, urine will include Salmonella typhi germs. Any food they touch may get contaminated if they don't properly wash their hands afterwards. If someone else consumes this meal, they could also get infected.

• In parts of the world with poor sanitation, infected human waste can pollute the water supply. Typhoid fever can strike people who drink contaminated water or consume food washed in contaminated water.

• Contaminated milk products.

• Eating seafood from a contaminated water source.

• Consuming raw vegetables that have been fertilised with human waste.

• Using ice made from contaminated water.

Risk Factors:

The risk factors for Typhoid fever are:

• Travel to endemic areas: People who travel to regions where typhoid is prevalent are at higher risk. Contaminated food and water in these areas can transmit the bacteria.

• Poor hygiene habits: Lack of proper hygiene, such as not washing hands thoroughly after using the restroom or before handling food, increases the risk.

• Poor sanitation conditions: Population without access to safe water and sufficient sanitation facilities are more susceptible to typhoid.

• Contact with someone recently suffering from typhoid fever: Close contact with an infected individual can transmit the bacteria.

• Crowded housing: Living in close quarters and having shared toilets can facilitate disease transmission.

• Consumption of raw fruits and vegetables contaminated with sewage: Consuming uncooked fruits and vegetables exposed to contaminated water or soil can lead to infection.

• Work with Salmonella enterica serotype typhi bacteria as a clinical microbiologist.

Possible Complications:

The two most common complications associated with typhoid fever include:

Intestinal bleeding: Typhoid fever can lead to damage and bleeding in the intestines. The infection affects the walls of the small intestine or large bowel, causing cells to die and allowing gut contents to leak into the body. It may cause symptoms such as pale skin, vomiting blood, breathlessness, stools that are very dark or tar-like, irregular heartbeat and feeling tired all the time.

Perforation: It is a very serious complication due to the possibility that germs from your digestive system could enter your stomach and infect the peritoneum, which lines the inside of your stomach. This is called Peritonitis. The most common symptom of Peritonitis is sudden stomach pain that gets progressively worse.    

Other possible complications include:

• Pneumonia

• Bladder or kidney infections

• Myocarditis (inflammation of the heart muscle)

• Mycotic aneurysm (infection of major blood vessels)

• Endocarditis (inflammation of the heart and valves lining)

• Pancreatitis (inflammation of the pancreas)

• Meningitis (infection and inflammation of the membranes and fluid surrounding the brain and spinal cord)

• Psychiatric problems, such as hallucinations, delirium (serious disturbance in mental abilities) and paranoid psychosis.

Prevention:

Here are some preventive measures you can take to reduce the risk of contracting typhoid:

Safe Water and Sanitation: Typhoid is common in areas with poor sanitation and insufficient access to safe drinking water. Ensure that you drink only boiled or chemically disinfected water to minimize the risk of infection.Avoid consuming water from unreliable sources or untreated wells. Also, avoid ice unless it is made from safe water. 

Hygiene Practices: Wash your hands with soap and water thoroughly after using the restroom or before handling food. Proper hygiene of hands help prevent the spread of typhoid bacteria. Food handlers should maintain good hygiene practices to prevent contamination of food.

Typhoid Vaccination: Consider getting vaccinated against typhoid if you are travelling to a high-risk area. Consult your healthcare provider at least 2 weeks before travelling to discuss vaccination options. The typhoid conjugate vaccine is recommended for children aged 6 months and older and adults up to 45 or 65 years (depending on the vaccine). Two vaccines have been prequalified by the World Health Organization (WHO) and are being introduced in typhoid-endemic countries. 

Remember that even after recovering from typhoid, individuals may still carry the bacteria in their intestines and shed it in their faeces. Proper hygiene practices are essential to prevent further transmission. Stay safe and take the necessary precautions!

When to see a doctor?

If you suspect having typhoid symptoms, it is essential to consult a doctor promptly. Remember, early diagnosis and treatment are essential for managing typhoid fever effectively. If your symptoms return, worsen, or new symptoms develop, call your healthcare provider immediately.

Here are some guidelines on when to seek medical attention:

Symptoms of Typhoid Fever: Typhoid fever typically presents with symptoms such as high fever, weakness, stomach pain, headache, and diarrhoea. If you experience any of these symptoms, especially if they persist or worsen, it is important to seek medical advice.

Recent Travel History: If you or a close companion recently travelled to an area with a high risk of typhoid fever, consult a doctor. Your doctor will consider your travel history and assess the likelihood of exposure to the bacteria.

Severity of Symptoms: If you have severe symptoms, do not delay seeking medical attention. Severe symptoms may include persistent high fever, dehydration, or abdominal discomfort.

Diagnosis:

Your healthcare provider will suspect typhoid fever based on your symptoms and medical history. The diagnosis is often confirmed by culturing the bacteria from a sample of your body fluid or tissue. Common samples include blood, stool, urine, or bone marrow.

Culture test: Under a microscope, the growth of typhoid bacteria is examined in a sample kept in an environment where bacteria grow easily. Bone marrow culture is often the most sensitive test for Salmonella Typhi.

Other tests may be used to confirm typhoid fever, such as detecting antibodies to typhoid bacteria in your blood or checking for typhoid DNA. 

Treatment:

Typhoid fever can be treated effectively with antibiotics. 

Antibiotics: Antibiotic therapy is the main treatment for typhoid fever. The choice of antibiotic depends on the strain of bacteria and the location of infection. Commonly prescribed antibiotics include:

• Fluoroquinolones: These antibiotics, such as ciprofloxacin, are often the first choice. They work by preventing bacteria from copying themselves. However, some strains of bacteria can be resistant to these antibiotics.

• Cephalosporins: This group of antibiotics prevents bacteria from building cell walls. Ceftriaxone is used in case of antibiotic resistance.

• Macrolides: These antibiotics inhibit bacterial protein synthesis. Azithromycin may be used in case of antibiotic resistance.

• Carbapenems: These antibiotics also inhibit bacteria from building cell walls but target a different stage of the process than cephalosporins. They are used for severe cases that don’t respond to other antibiotics.

Other Treatments:

• Fluids: Drinking fluids helps prevent dehydration caused by prolonged fever and diarrhoea. In severe cases, intravenous fluids may be necessary.

• Surgery: If the intestines are damaged, surgery may be needed.

If you suspect typhoid fever, remember to seek medical attention promptly, especially if you have recently travelled to a high-risk area.