Typhoid fever, diarrhea, and vomiting are all symptoms of a bacterial infection called typhoid. It has the potential to be fatal. Salmonella typhi is the bacteria that causes it. The virus is spread by contaminated food and water, and it is more common in areas where handwashing is not practiced. It can also be spread by carriers who are unaware that they are carrying the germs.
Each year, around 5,700 cases are reported in the United States, with 75 percent of these illnesses beginning while travelling internationally. Typhoid affects around 21.5 million people worldwide each year. Typhoid can be successfully treated with medicines if discovered early; if not treated, typhoid can be fatal.
What are the Signs and Symptoms of Typhoid Fever?
Symptoms usually appear six to thirty days following contact to the pathogen. Typhoid fever and rash are the two most common symptoms. Typhoid fever is very severe, with temperatures rising to 104 degrees Fahrenheit (39 to 40 degrees Celsius) over several days. Rose-colored patches, mainly on the neck and belly, characterize the rash, which does not afflict every patient.
Some common signs of enteric fever are:
- Fatigue
- High fever
- Loss of appetite
- Headache
- Nausea
- Delirium
- Sore throat
- Rashes
- Abdominal ailments
- Diarrhea
Many times, people carry the bacteria but do not show these signs. The symptoms develop gradually and often show up after 1-3 weeks. Some people carry the bacteria but do not get affected. They are asymptomatic carriers with no symptoms or signs.
If you feel any of these signs, consult your doctor quickly.
When to see a doctor?
Once you suspect you have typhoid fever, see a doctor immediately. Your doctor will diagnose and treat your illness wisely. To avoid complications, set up an appointment immediately after you have returned from a trip.
If you experience mild or severe symptoms, do not hesitate and reach out to your physician at the earliest.
Who is at more risk?
Typhoid and paratyphoid are frequent in parts of the world where sanitization is compromised. You are at a higher risk of developing these diseases if you have travelled to Africa, the Caribbean, Central and South America, the Middle East, and the Eastern and Southern Asia, including Pakistan, India, and Bangladesh.
Also, people who visit their friends and family have a greater chances of contracting typhoid fever as they stay in the country longer, are less thoughtful about the food and drinks they consume made by the local eateries and may fail to get vaccinated before the trip.
Each year in the United States, nearly 425 people are diagnosed with typhoid fever and close to 125 people are diagnosed with paratyphoid fever. Most of them had a history of internationally travelled.
How to Diagnose Typhoid Fever?
Typhoid diagnosis involves:
- Testing antibodies against Salmonella typhi
- Laboratory tests to check fever
- Blood, stool, and urine samples
- Bone marrow testing
- Blood culture
The diagnosis is primarily clinical. But the most common techniques are using a stool sample or blood test. Tell your doctor if you have traveled recently. This will help identify the disease properly and at the right time to prevent complications.
On average, 3%-5% of patients become carriers of the bacteria after diagnosis.
Widal Test
The test identifies antibodies in the serum of typhoid patients with the help of antigen-antibody interactions.
The pathologists mix the serum with dead bacterial suspension of Salmonella with specific antigens. In this test, when the antigens are implanted into the serum with antibodies, the antigens attach and blood forms clumps. If clumping fails to occur, the test is negative. It is time-consuming and may have an increased chance of generating false positives. It can also show false negatives in recently infected individuals. Compared to the Typhoid test, this test computes the specimen with titres.
Rapid Diagnostic Tests
The various rapid diagnostic tests, namely Tubex and Typhidot, shows moderate diagnostic accuracy.
Typhidot
This test identifies IgM and IgG antibodies to specific 50Kd OMP antigens when a cellulose nitrate membrane is attached with S. typhi outer membrane protein. It identifies IgM and IgG antibodies – the presence of IgM shows a recent infection, and the IgG means a remote infection.
The sample collection pad of the kit includes colloidal gold-ant-human IgG or gold-anti-human IgM. If your sample specimen with IgG and IgM antibodies reacts to the antigens on the collection pad, it turns red. The test shows a positive result within two to three days of infection.
A two-coloured band indicates a positive test, whereas a single line means a negative result. A single fixed line or no line may indicate an invalid test. However, the biggest drawback of this test is that it simply notifies positive or negative but doesn’t show a quantative result.
Tubex test
The test contains two types of particles: brown magnetic particles coated with antigen and blue indicator particles coated with O9 antibody. The antibodies in the serum will react to the brown magnetic particles and remain at the base, whereas the blue indicator remains the same, producing a blue colour. It indicates a positive result.
However, if no antibody is present in the serum, the blue particles get connected to the brown particles to settle at the bottom, resulting in a colourless solution. This means a positive result.
What are the Causes of Typhoid Fever?
Typhoid fever is a severe intestinal infection. It may be caused in the following ways:
Fecal-oral transmission route
This includes a lack of proper sanitation and poor hygiene practices. In humans, water-borne diseases are the carriers. Fecal contamination also occurs through food, water, and direct contact.
In developing countries, where enteric fever is endemic, most infections originate from drinking contaminated water. Travelers spread the disease through a fecal-oral route.
So, the bacteria responsible passes in the feces. It also stays in the urine of infected people. You can also catch the infection if you get in contact with someone suffering from typhoid fever.
Typhoid carriers
There are some patients who, even after recovery, carry the disease in their intestinal tracts or gall bladders for quite some time. These carriers shed bacteria in the feces, causing infection to other people.
What are the Risk Factors for Typhoid?
Typhoid is a serious illness affecting millions of people around the world every year. Children are at higher risk of this disease.
Listed below are the risk factors that increase the chances of infection.
- Unhygienic living conditions
- Poor sanitation
- Frequent traveling to affected areas
- Coming in contact with a person suffering from typhoid
- Touch to a flying insect feeding feces
- To avoid typhoid infection, we advise you to stay away from the risks given above.
However, if you still get an infection, contact your doctor for timely diagnosis and treatment.
What are the Complications Associated with Typhoid Fever?
The most dangerous consequences of typhoid fever are gastrointestinal bleeding or holes. They commonly appear in the third week of a sick person’s illness. The small intestine or big bowel develops a hole in this disorder. The contents of the intestine flow into the stomach, causing severe stomach pain, nausea, vomiting, and infection in the bloodstream (sepsis). This life-threatening condition necessitates prompt medical attention.
Complications occur in patients who do not undergo the proper antibiotic course. 1 out of 10 individuals experiences such risks. The most common ones observed are:
- Splitting of the digestive system: Splitting or Perforation is a serious issue. In this, the bacteria move to the stomach and infect the abdomen lining (peritoneum). The condition is peritonitis.
- The peritoneum lacks an inbuilt defense system for fighting infection. Therefore, the infection spreads rapidly to the blood and results in a medical emergency. If not treated at the right moment, it results in multiple organ failures and ultimately, the patient’s death.
- An emergency pain in the abdomen is the only symptom. It makes the situation even worse. In this condition, admission to the hospital is very important. Your doctor gives antibiotic injections, followed by surgery to seal the intestinal wall.
Prevention
Vaccines, according to some experts, are the most effective strategy to prevent typhoid illness. If you live in or plan to go to locations where typhoid disease is a serious threat, you should get vaccinated. There are two vaccinations available.
- At least one week prior to travel, one is administered as a single shot.
- One is given orally in the form of four capsules, one of which is taken every other day.
Neither vaccine is guaranteed to be 100 percent effective. Because their potency fades out over time, both require repeated vaccines. When going to high-risk areas, observe these instructions because the vaccine won’t provide total protection:
- Please wash your hands.
- Do not drink untreated water.
- Raw fruits and vegetables should be avoided.
- Choose foods that are spicy.
- Find out where the doctors are located.
- Prevent infecting others
If you’re recovering from typhoid fever, take these precautions to protect others:
- Take your antibiotics as directed – Take your antibiotics according to your doctor’s recommendations, and make sure you finish the entire prescription.
- Hands should be washed frequently – This is the single most critical thing you can do to prevent the illness from spreading further. Scrub thoroughly for at least 30 seconds with hot, soapy water, especially before eating and after using the restroom.
- Food should not be handled – Wait until your doctor says you’re no longer contagious before preparing food for others. You won’t be allowed to return to work in the food service business or a health care facility until tests confirm you’re no longer shedding typhoid bacteria.
Treatment
Treatment at home
If you are identified with typhoid fever early on, you may be given antibiotic medications to take. The majority of people must take them for 7 to 14 days. Some strains of Salmonella typhi, which causes typhoid fever, have developed resistance to one or more antibiotics. Within 2 to 3 days of starting antibiotics, your symptoms should start to improve.
However, it is critical that you complete the course in order to ensure that the germs are entirely gone from your body. Make sure you get plenty of rest, drink plenty of water, and eat regularly. If your symptoms worsen or you develop new symptoms while being treated at home, contact your doctor as soon as possible.
Dietary Recommendation for a Person with Typhoid
- Eat small meals at frequent intervals
- Electrolyte and fluid levels must be maintained
- One must have a high protein and low fiber diet
- Bland and soft diet
- Fried, fatty, and spice food must be avoided
Hospital treatment
If you have severe typhoid fever symptoms, such as continuous vomiting, severe diarrhea, or a bloated stomach, you should go to the hospital. Young toddlers with typhoid fever may be admitted to the hospital as a precaution. Antibiotic injections will be administered to you in the hospital, and you may also be given fluids and nutrients directly into a vein via an intravenous drip.
If you have life-threatening typhoid fever complications, such as internal bleeding or a portion of your digestive system breaking, surgery may be required. However, in patients taking antibiotics, this is quite unusual. The majority of patients respond well to hospital care and improve within 3 to 5 days, but it may take many weeks for you to feel well enough to go.
Typhoid Fever Vaccination
If you are a United Kingdom citizen, the doctors recommend taking two vaccinations to protect yourself against typhoid fever. The vaccination may be given either through a single injection or three capsules for alternative days. These vaccines are highly recommended for travellers visiting the parts of the world where the disease is prevalent. The following are some of the countries with the highest rate of typhoid fever:
- The Indian subcontinent
- Africa
- The South and Southeast Asia
- South America
It is crucial to get vaccinated when you are travelling to typhoid-prone areas because:
- Certain typoid strains are antibiotic resistant.
- Planning to live or work with the local people
- The vaccine may not be completely effective; as a result, you must be cautious when travelling. Ensure you drink bottled or boiled water, and say no to possibly contaminated food.
Oral Rehydration Therapy
Due to the rediscovery of oral rehydration therapy in 1960, several deaths due to diarrhoea-related diseases were effectively prevented.
Antibiotics
It is rare for typhoid fever to be resistant. However, doctors treat patients with typhoid fever with antibiotics such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, amoxicillin, and Ciprofloxacin. These commonly used medications reduce the case-fatality rate to nearly 1%.
However, if a patient fails to get treatment, they may develop the following
- Sustained fever
- Bradycardia
- Hepatosplenomegaly
- Abdominal symptoms
- Occasionally pneumonia
In white-skinned patients, pink spots on the trunk may fade away by pressure in nearly 20% of cases. However, if typhoid fever goes untreated for the third week, it may develop into gastrointestinal and cerebral complications that can be fatal in nearly 20% of cases. Children under the age of 4 years are reported to have the highest case of fatality. And nearly 5% of them go on to become chronic carriers, meaning the bacteria remains in the biliary tract after symptoms have resolved.
Surgery
If the doctor recommends surgery, it means the intestine has perforated. Most doctors prefer to use the simple closure technique. However, when the small bowel is resected, it is a sign that the patient’s intestine is perforated in multiple places. Surgery is only recommended when antibiotics fail to treat the hepatobiliary carriage and the gallbladder needs to be saved. Certain surgeries are successful but do not entirely eliminate the carrier state due to constant infections.
Resistance
Sometimes patients with typhoid fever develop resistance to various medications, namely ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and streptomycin. Such cases are known as multidrug-resistant typhoid. Therefore, these are not used as the first treatment option against typhoid fever.
Ciprofloxacin is another medication that fails to treat typhoid fever effectively in patients of the Indian subcontinent or Southeast Asia. Therefore, several healthcare centres are shifting from Ciprofloxacin as the first treatment option in South America, Pakistan, India, Bangladesh, Thailand, and Vietnam.
Azithromycin is an oral medication that is a better alternative to Ciprofloxacin and fluoroquinolone in treating resistant typhoid fever. It is also more affordable than Ciprofloxacin, given in an injection form.
Researchers have hit a roadblock in laboratory testing of reduced susceptibility to Ciprofloxacin. The recommendation is to conduct tests against Ciprofloxacin and nalidixic acid simultaneously. If the results show sensitivity to both CIP and NAL, it is reported as “sensitive to Ciprofloxacin” but fails with NAL and is shown as “reduced sensitivity to Ciprofloxacin.” However, this method fails to detect reduced susceptibility to fluoroquinolones.
Conclusion
It is contagious to have enteric fever. It gets severe and fatal if not treated in a timely manner. As a result, we recommend that you adopt cleanliness and appropriate hygiene measures to avoid contracting the disease. During healing, the body remains weak and requires appropriate nutrients. As a result, it is critical to combine medication with a suitable and healthy diet.
As noted previously, take the necessary preventative precautions. When visiting a region where typhoid is common, use caution. To avoid the spread of this dangerous disease, make sure you get your drugs on time and complete the entire treatment process.
Frequently asked questions
How long does typhoid fever last?
If the patient gets prompt treatment, the symptoms subside within three to five days. If the fever is not treated, it worsens in a few weeks and may develop into life-threatening complications. The symptoms may last for weeks or months to fully recover without treatment. However, there is a high chance of reoccurrence.
Which organ is affected by typhoid?
As typhoid is a bacterial infection, it affects multiple organs. Once it reaches the bloodstream, the bacteria attack the gastrointestinal tract – liver, spleen, muscles, gallbladder, lungs, and kidneys.
What should be avoided in typhoid?
Fibre-rich foods should be avoided or limited to patients with typhoid. Thus, helping them in digestion. The following are some of the foods to avoid:
- Raw vegetables and fruits
- Whole grains
- Nuts
- Seeds
- Legumes
- Spicy food
- Oily food
