Typhoid Fever

Definition

Typhoid fever is a type of bacterial infection characterized by high fever, stomach pain, headache, and gastrointestinal disturbances like constipation or diarrhea. Typhoid is caused by Salmonella typhi bacteria. Majority of typhoid patients respond well to antibiotics and recover within a few days. In rare cases, typhoid can lead to severe complications and even death.

Symptoms

The symptoms of typhoid fever appear 1 to 3 weeks after exposure to the Salmonella typhi bacteria. Symptoms can be divided into the presentation from week 1 to week 4.

Week 1

  • High fever (103 to 104 F)
  • Weakness
  • Headache
  • Sore throat
  • Stomach pain
  • Diarrhea (in kids) or constipation (in adults)
  • Rash on lower chest or upper abdomen

Week 2

In addition to high fever, rash and gastrointestinal problems, the following symptoms appear in the second week of illness:

  • Significant weight loss
  • Bloated or distended stomach

Week 3

  • Change in mental state – delirium
  • Typhoid state (lying motionless with eyes half-closed)

Week 4

  • Decrease in body temperature

If untreated, patients may develop the following life-threatening complications in the third week of infection:

  • Intestinal bleeding or perforation (most serious) with decreased blood pressure and shock
  • Severe stomach pain, nausea, vomiting, blood in stool, and sepsis

In some patients, inflammation of the heart muscles (myocarditis) or pancreas (pancreatitis), pneumonia, neurological symptoms (e.g., hallucinations, delirium, and paranoia), and infections of kidney, bladder, spine (osteomyelitis) or membranes covering the brain and spinal cord (meningitis) occur.

In the absence of any treatment, some individuals die of these complications. However, upon prompt treatment, almost all patients recover from typhoid.

Causes

S. typhi bacteria is transmitted in two ways :

  • Fecal-oral route: S. typhi spreads through contaminated water or food or via direct contact with an infected person. The bacteria are passed in the feces or the urine of the patients. Food cooked or handled by an infected person carries the bacteria. Similarly, drinking water also gets contaminated with the bacteria.
  • Typhoid carriers: Some patients harbor the bacteria in the gastrointestinal tract or gallbladder, despite treatment with antibiotics and recovery. Such individuals may themselves be asymptomatic but shed the bacteria in the feces. These people are called chronic carriers and can infect others.

Working in or traveling to areas where S. typhi infection is common, sharing things and clothes with an infected person or chronic carrier, and drinking water contaminated by sewage that contains S. typhi bacteria increase the risk of typhoid fever. People with weak immune systems due to medications (like corticosteroids) or diseases (like HIV/AIDS) are more susceptible to S. typhi infection.

Treatment

S. typhi infection is diagnosed by culturing blood or other body fluids (urine, bone marrow) from the suspected patients. Antibiotics like ciprofloxacin are effective in clearing infection. Ceftriaxone is recommended to pregnant women and children. Overuse of antibiotics can make the bacteria resistant to them.

Typhoid vaccines are available but no vaccine ensures 100% efficacy against typhoid fever.

Drinking plenty of fluids prevents dehydration. A high-calorie diet restores the energy levels. Simple measures like washing hands thoroughly before handling food and after using the toilet, not drinking contaminated or untreated water, and avoiding raw fruits and vegetables may prevent infection.

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