Typhoid Fever

Typhoid is an age-old intestinal infection most commonly caused by the bacteria Salmonella typhi. It is highly prevalent in areas with inadequate access to clean water and sanitation. Transmission of the disease is from human to human. It usually spreads by food and water that has been contaminated with feces of an infected person.

Other names #

Also known as typhoid fever, enteric fever

Causes #

Typhoid fever is caused by the bacteria Salmonella typhi. The bacteria is transmitted through the oral-fecal route by consumption of water or food contaminated by feces of an acutely infected or a chronic, asymptomatic carrier. The various reasons of getting infected could be:

• You eat food or drink a beverage that has been touched by a person who is carrier and is shedding Salmonella Typhi in their poop and who has not washed their hands thoroughly after going to the bathroom

• Consuming water that has been contaminated with infected fecal matter containing Salmonella Typhi

• Contaminated water used to rinse fruits and raw vegetables

• Using ice made out of contaminated water

• Fruits and vegetables grown in soil contaminated with infected feces

• Milk that has been diluted with contaminated water

Symptoms #

Irregular fever that can go up to 104.9 ˚F (40.5 ˚C)

• Headache

• Pain in the abdomen

• Tiredness and weakness

• Muscle pain

• Loss of appetite/anorexia and weight loss

• Constipation or diarrhea

• Confusion

• Low pulse rate

• Rose colored spots on the neck, chest or abdomen

• Swollen stomach

• Dry cough

Risk factors #

• Traveling to endemic areas: There are some parts of the world that are worst affected by typhoid.If possible, avoid traveling to these places especially in the peak season of the disease.

• Poor Hygiene Habits: Hygiene plays a very important role in preventing a lot of diseases including typhoid. Good hygiene practices like washing hands after using the toilet and before eating food can keep you safe from contracting typhoid.

• Consuming contaminated fruits and vegetables: Fruits and vegetables can also get contaminated if they are washed with dirty water or grown in soil polluted by human excreta.

• Poor sanitation conditions: Exposure to contaminated environment and proximity to flying insects that can carry germs from feces increases the risk of typhoid.

• Coming in close contact with a person having typhoid: Coming in close contact with a person suffering from typhoid

• Health care workers: Healthcare workers at the ones at the maximum risk of infections. Since they handle the patients day and night, it is easy for them to contract the disease

• Crowded housing with shared toilets: People living in crowded areas with shared toilets are more susceptible to typhoid.

Diagnosis #

Blood tests #

This includes tests to detect IgM and IgG antibodies and blood culture tests to detect the bacteria Salmonella typhi.

Stool and urine analysis #

To check for the presence of the bacteria in the stool and urine samples.

Bone marrow culture #

This test is also recommended but it is rarely required except in patients who have already received antibiotics and are not getting better. It is one of the most sensitive tests for typhoid fever.

Widal antigen test #

This test can be done in two ways: Slide agglutination and Tube agglutination.The results are obtained after a longer waiting phase of about 10 days. The conventional widal test detects antibodies to S.typhi from 2nd week of onset of symptoms.

Typhi dot tests #

Typhi tests serve as a marker for recent infections. It can detect early rising antibodies that are predominantly IgM.

Treatment #

Antibiotic therapy #

Antibiotics are the first line and only effective treatment option for typhoid fever. In most areas, fluoroquinolones are the most effective drug of choice. However, they are increasingly met with resistance.

Some of the commonly used fluoroquinolones are:

• Ciprofloxacin

• Amoxicillin

• Trimethoprim-sulfamethoxazole

• Chloramphenicol

Due to increased resistance to ciprofloxacin, the newer drugs of choice are:

• Azithromycin

• Ceftriaxone

Vaccination prophylaxis #

The vaccine is recommended for those traveling to areas with a high risk of exposure. The World Health Organization Strategic Advisory Group of Experts on Immunization recommended the use of typhoid conjugate vaccines (TCVs) in India. It is given as intramuscular, single-dose vaccines for those above 6 months and older.

Miscellaneous treatment #

This includes supportive and symptomatic care such as:

• Maintaining adequate hydration during diarrhea

• Ensuring proper ventilation and oxygenation for respiratory complications

• Using analgesics and antipyretics to manage the symptoms

• Making sure to use safe drinking water and follow proper hygiene and sanitation