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Typhoid

Overview

Typhoid fever is a bacterial infection caused by salmonella typhi bacteria and spread through food or water spoiled by bacteria. It is common in developing nations. Symptoms can range from mild to severe and can be fatal if left untreated. It presents as high-grade fever, vomiting, abdominal pain, constipation, headache, etc. it is diagnosed by blood culture and treated with antibiotics.

Causes

Typhoid fever, also known as enteric fever, is caused by Salmonella Typhi and sometimes by bacteria paratyphi A, B, C. A person can get infected by consuming food or water soiled by bacteria either through infected feces or by the infected person who touches your food without washing hands after using the toilet. Sometimes people shed bacteria in their feces (body waste) without having any symptoms. They are called asymptomatic carriers. The bacteria enter the gastrointestinal tract, grow and multiply and then enter the blood.

Epidemiology

The virus is usually found in developing countries or low socioeconomic areas where there is a lack of hand-washing and hygiene practices. People can acquire it by traveling to such areas. It can infect any age group, but most commonly, it affects children and young adults.

Risk Factors

You can acquire the infection if you:

  • Travel to areas where typhoid is endemic
  • Travel to areas with poor sanitation
  • Eat food from the street
  • Drink contaminated water
  • Eat raw vegetables and fruits without washing in endemic regions

Signs And Symptoms

It may take up to 7-14 days to show symptoms after being infected.  Without treatment, the symptoms may progress in severity over three weeks, ultimately leading to serious complications.
Early-stage:

  • Rising fever that starts slowly then rise to 104 degrees and gradually increases in intensity over days
  • Slowed heartbeat
  • Headache
  • tiredness and fatigue
  • cough
  • abdominal pain
  • constipation or diarrhea
  • Rose spots ( salmon-colored rashes on the trunk)
    Late-stage:
  • Very high fever along with dehydration
  • Confusion and psychosis
  • Intestinal hemorrhage
  • Intestinal perforation
  • Pneumonia or bronchitis (lung infections)
  • Hepatomegaly (liver enlargement)
  • Encephalitis (brain inflammation)

Diagnosis

The diagnosis is made by history, physical examination, and laboratory investigations which are specific and nonspecific and usually tested on your blood but can also be performed on stool and bone marrow.
Blood culture is the gold standard test in which bacteria is grown in the lab and sensitivity to the medicines is established, which is very important due to the emergence of resistant bacteria.
Serological testing involves checking for the antibodies in your blood against the bacteria. They include the Widal test and ELISA test.
Non-specific blood tests would be performed to monitor the disease like complete blood count (CBC-which can show infection, anemia, low platelets), PT, PTT, electrolytes, liver enzymes.

Differential Diagnosis

Other diseases that can present as typhoid fever include:

  • Malaria

  • Dengue fever

  • Liver abscess

  • Leishmaniosis

  • Appendicitis

 

Treatment

For successful treatment, typhoid should be promptly diagnosed and treated. It is recommended to start the empirical treatment according to the sensitivity of the endemic bacteria instead of waiting for the blood culture test results. Later on, the medicines can be changed according to the sensitivity of the culture report. General care of diet and hydration must be taken. There is no limitation of activity, but rest is beneficial.
Antibiotics: Until the bacterial sensitivity results, the following medicines can be started empirically.

  • Ceftriaxone or cefixime ( third-generation cephalosporin)
  • Ciprofloxacin (fluoroquinolone)
  • Azithromycin
  • Chloramphenicol
    Surgical care: In cases of complications, surgical procedures may need to be performed.
    Follow-up care: your doctor may advise follow-up care to check for relapse or complications. It is done for at least three months after the commencement of medications. You may be asked to submit a stool sample to check for bacteria to rule out the carrier state.
    Asymptomatic carriers:  a career is a person who shows no symptoms of the disease after being treated but can continue to shed bacteria in feces or urine. Such people can spread the disease without having any knowledge about it. You should finish the entire course of prescribed antibiotics. Wash hands correctly after using the toilet and before making food. Avoid serving food and drinks to others.
    Treatment of carriers does not provide them complete cure. Vaccination is also not helpful for the carriers; however, vaccination to their contacts should be offered. Carriers are restricted from some jobs, especially cooking and serving food, and are strictly educated about prevention of spread by practicing hygienic protocols and safely disposing of feces and urine. They are given a certificate of clearance once they stop shedding bacteria. 

Prognosis

Typhoid can be treated with antibiotics and, it has a good cure rate. However, it depends upon how quickly the infection is diagnosed and the treatment is started. Without treatment, the disease can persist for 4-8 weeks. Untreated cases can have fatal consequences like gut perforation, intestinal bleeding, pneumonia and acute bronchitis (lung diseases), encephalitis (brain inflammation), liver abscesses, etc.
So, any high-grade fever and history of traveling should trigger a prompt diagnosis, and treatment should be started.

Prevention

The spread of disease and the chances of infection can be prevented by:

  • Taking care of sanitation and hygiene
  • Cooking food carefully and washing hands before it
  • Drinking safe bottled water or boiled water
  • Avoid eating street food
  • Avoid using ice in the drinks
  • Washing and peeling vegetables and fruits efficiently
  • Vaccination: two vaccines have been prepared for endemic areas and travelers. One is given orally, and one is injectable. These vaccines do not provide 100% protection against bacteria, so sanitation and hygiene must be practiced.

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