Typhoid is one of the most common enteric infections (disease of the intestine caused by an infection). In 2015, it is estimated that around 17 million cases of typhoid and paratyphoid fever occurred worldwide, with the highest number of cases in Southeast Asia. According to a 2018 study, the prevalence of typhoid cases in India is estimated to be 9.7%. Typhoid fever is believed to be responsible for an estimated 129,000–161,000 deaths each year. Characterized by diarrhea, abdominal discomfort, nausea and vomiting, typhoid if left untreated can lead to death. Given that typhoid is quite common in India, it is important to know about the causes, symptoms, treatment, and prevention of the condition to be aware of typhoid before it strikes you and your family.
What are the causes of Typhoid fever?
As you might be aware of, typhoid fever or enteric fever is a serious bacterial infection which is characterized by high fever, severe headache, and abdominal pain or discomfort. A very common condition in developing countries like India, typhoid fever is caused by a bacterium called Salmonella typhi. The bacteria is transmitted through contaminated water or food either through fecal-oral or urine-oral route.
There are certain factors which can increase the risk of typhoid fever. These include:
-Traveling to areas where typhoid fever is a common disease (endemic areas).
-Being in a profession where contamination with bacteria is likely for example, those working in laboratories and hospitals.
-Coming in close contact with a person suffering from typhoid.
-Drinking contaminated water or eating contaminated food.
What are the signs and symptoms of typhoid fever?
As typhoid is an enteric infection, it affects the intestine and hence, the symptoms you might experience are related to digestion. Generally, the signs and symptoms of typhoid fever develop gradually over the period of 10-14 days after exposure to the bacteria. The typical signs and symptoms which indicate you might have the condition include
– Irregular fever that can go up to 104.9 ˚F (40.5 ˚C)
– Pain in the abdomen
– Tiredness and weakness
– Muscle pain
– Loss of appetite/anorexia
– Nausea and vomiting
– Constipation or diarrhea
How is typhoid fever diagnosed?
If anyone in your family suffers from typhoid or if you experience any signs and symptoms of typhoid fever, it is wise to consult a doctor. Your doctor will do a physical examination and order a few tests to diagnose the condition. Physical findings in early stages include abdominal tenderness, enlarged spleen and liver, enlarged lymph nodes, and development of a rash (also known as rose spots because of their appearance). However, the clinical presentations may vary from person to person.
The laboratory investigations include:
– Blood tests include a test to detect IgM and IgG antibodies and blood culture test to detect the bacteria Salmonella typhi.
– Stool and urine analysis to check for the presence of the bacteria.
– Bone marrow culture is also recommended but it is rarely required except in patients who have already received antibiotics and not getting any better. It is one of the most sensitive tests for typhoid fever.
– Widal antigen test can also be done, but there is a longer waiting phase of about 10 days till results can be seen. The conventional Widal test detects antibodies to S.typhi from 2nd week of onset of symptoms.
– Typhi dot tests can serve as a marker for recent infections. It can detect early rising antibodies that are predominantly IgM.
What is the treatment for typhoid fever?
Antibiotics are the only effective treatment option for typhoid fever. Due to increased resistance to ciprofloxacin the new drugs of choice are azithromycin and ceftriaxone. In some cases, chloramphenicol, co-trimoxazole, and amoxicillin may also be effective. Fluid intake should be increased to prevent dehydration.
What are the complications of typhoid fever?
If not treated and sometimes even after treatment, there can be serious complications due to typhoid such as pneumonia, meningitis (inflammation of the meninges of the brain), infection in bones (osteomyelitis), intestinal perforation and intestinal haemorrhage. A doctor needs to be consulted if a person starts developing the symptoms a few days after traveling to a place where typhoid is prevalent.
How can typhoid fever be prevented?
– Typhoid fever can be prevented by improving sanitation facilities and drinking clean drinking water as the primary mode of transmission is through food and water.
– Always wash your hands with soap and warm water after using restrooms, before eating or cooking food.
– Maintain optimum personal hygiene as it is the key to preventing this disease.
– Travelers should not drink untreated water; avoid adding ice to their drinks and should not eat ice cream or milk products or street foods that are a rich source of the infection.
– Vaccines are available that give partial protection. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.
As typhoid is quite common during monsoon due to high chance of water and food contamination, is it advised to stay healthy and safe during this period. Also, if anyone in your family suffers from the condition, it is important to follow all the necessary hygiene and sanitation measures. Remember, following simple precautionary measures and knowing about the causes, symptoms, and treatment of typhoid fever can go a long way to treat it and prevent health complications. Stay healthy, stay protected.
(The article is reviewed by Dr. Swati Mishra, Medical Editor)
1. Balaji V, Kapil A, Shastri J, et al. Longitudinal Typhoid Fever Trends in India from 2000 to 2015. Am J Trop Med Hyg. 2018 Sep;99(3_Suppl):34-40.