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Typhoid fever

Typhoid fever

Also known as typhoid fever, enteric fever

Overview

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.


Typhoid is characterized by symptoms like fever, abdominal discomfort, loss of appetite, weakness, rash, headache, constipation or diarrhoea. Typhoid fever is treated with antibiotics and a timely treatment ensures quick recovery in most of the cases. If left untreated, it can lead to life-threatening complications.


Typhoid can mostly be prevented with good hygiene habits and consumption of purified water. Vaccination for typhoid is also available but is only partially effective. They are usually recommended to those travelling to areas where typhoid is endemic.

Key Facts

Usually seen in
  • Children aged 6 months to 3 years
  • Adults between 5 and 19 years old.
Gender affected
  • Both Men and Women, but more common in younger children
Body part(s) involved
  • Stomach
  • Intestine
Prevalence
  • Worldwide: 11–21 million cases annually (2018)
  • India:  4.5 million cases annually(2021)
Mimicking Conditions
  • Dengue fever
  • Malaria
  • Amebiasis
  • Leptospirosis
  • Q fever
  • Giardiasis
Necessary health tests/imaging
Treatment
Specialists to consult
  • General Physician
  • Pediatrician (in case of children)
  • Internal Medicine Specialist
  • Infectious Disease Specialist

Symptoms Of Typhoid Fever

Typhoid is a bacterial infection which affects the intestine. Generally, the signs and symptoms of typhoid fever develop gradually over the period of 10-14 days after exposure to the bacteria. Onset of the disease is usually gradual. The typical signs and symptoms of typhoid include:

  • 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


Later as the infection progresses a person may show signs of extreme exhaustion and lie still with the eyes half-closed. This is referred to as the typhoid state. Typhoid may prove to be fatal if left untreated, as it can lead to many complications. 

Causes Of Typhoid Fever

Typhoid is highly prevalent in areas with inadequate access to clean water and sanitation. That is why developing countries and underdeveloped countries in Africa, South America, and Southeast Asia are known to be endemic for typhoid.

 

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 

Who Should NOT take the Typhoid vaccine?
Talk to your doctor before getting vaccinated. If you have the following issues: Have had an allergic reaction after a previous dose of typhoid vaccine, or have any severe, life-threatening allergies. Have a weakened immune system. Are pregnant or breastfeeding, or think might be pregnant. Are taking or have recently taken antibiotics or anti-malarial drugs. Consult our doctors to seek professional help.
Who Should NOT take the Typhoid vaccine?

Risk Factors For Typhoid Fever

There are certain factors that can increase the risk of typhoid fever. These include:

  • 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 Of Typhoid Fever

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 advise a few tests to diagnose the condition. Physical findings in the early stages include abdominal tenderness, enlarged spleen and liver, enlarged lymph nodes, and the 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: 

1. Blood tests

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


2. Stool and urine analysis

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


3. 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.


4. 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. 

5. Typhi dot tests

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


Book your test now, by just sitting back at home. 

Celebs affected

Arnold Bennett
He was a famous English novelist, who died in 1931 because of typhoid, after unwisely drinking tap water in a Paris restaurant, despite being advised by the waiter not to do so.
Mary Mallon
Commonly known as Typhoid Mary, she was an Irish born american cook who was identified as the first asymptomatic carrier of the disease in the United States.

Prevention Of Typhoid

Typhoid can be prevented by following good hygiene practices such as:

  • Drinking only purified or mineral water.

  • Always wash your hands with soap and water after using restrooms, before eating or cooking food.

  • Improving sanitation facilities or avoiding common unhygienic toilets.

  • Maintaining optimum personal hygiene like avoiding sharing towels and other personal care items.

  • Travelers should avoid drinking untreated water, adding ice to their drinks, roadside, uncooked or unhygienic food.

  • Two vaccines are available for people travelling to areas where risk of typhoid fever is high. One is given as a single shot at least one week before travel. Other is given orally in four capsules, with one capsule to be taken every other day. Neither vaccine is 100% effective. Both require repeat immunizations because their effectiveness wears off over time.

Specialist To Visit

If you suspect having symptoms of typhoid do not hesitate and reach out to your General physician at the earliest. If you test positive for typhoid you can also consult the following:

  • Pediatrician (in case of children)

  • Internal Medicine Specialist

  • Infectious Disease Specialist


Take our medical professionals advice and learn more about your symptoms. 

Typhoid vaccine is not 100% effective and is not a substitute for being careful about what you eat or drink.
There are two vaccines to prevent typhoid fever. One is an inactivated (killed) vaccine and the other is a live, attenuated (weakened) vaccine. But vaccination is required time and again to safeguard oneself from typhoid, as the efficacy of vaccine wears off over time. Read more about typhoid fever treatment and prevention.

Treatment Of Typhoid

1. 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:

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

2. 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.


3. 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

Did you know?
Even after antibiotic treatment, a small number of people who recover from typhoid fever continue to harbor the bacteria. These people, known as chronic carriers, no longer have signs or symptoms of the disease themselves. However, they still shed the bacteria in their feces and are capable of infecting others.
Did you know?

Home Care For Typhoid

  • If typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed. Most people need to take antibiotics for 7 to 14 days.

  • Take ample amount of rest.

  • Drink plenty of fluids like purified water, coconut water, herbal teas, electrolyte solutions and clear soups.

  • Eat light, healthy, nutrient dense and hygienic food that is easy to digest. A good nutritious balanced diet should should include:

    High calorie foods such as boiled potatoes, boiled rice, banana, porridge, etc.

    Water rich fruits such as watermelons, grapes, muskmelons, oranges, etc.

    Plenty of fluids such as purified water, fresh fruit juices, coconut water, lime water, buttermilk, soups, etc.

    Dairy products such as milk, curd, and eggs.

  • Avoid deep fried, oily and junk food as it can cause stomach pain as well bloating. 

    High fiber foods such as whole grains and cereals.

    Oily foods such as butter, fried foods, etc

    Spices such as turmeric, chilies, vinegar, pepper, etc.

    Raw vegetables like cabbage, capsicum, radish, etc

  • Maintain good standards of personal hygiene, such as regularly washing hands and thus reducing the risk of spreading the disease. 

  • Keep in touch with your General Physician if new symptoms develop while being treated at home.

Complications Of Typhoid Fever

Complications caused by typhoid fever usually only happen in people who haven't been treated with appropriate antibiotics. About 1 in 10 people experience complications, which usually develop during the 3rd week of infection.

The 2 most common complications in untreated typhoid fever are:

1. Internal Bleeding in the digestive system 

Most internal bleeding that happens in typhoid fever isn't life-threatening, but it can make you feel very unwell. Few Symptoms of internal bleeding are:

  • Feeling tired all the time

  • Breathlessness

  • Pale Skin

  • Irregular heartbeat 


2. Splitting (Perforation) of a section of the digestive system 

Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen. This is known as Peritonitis. The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.


What will happen if typhoid is left untreated?

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)

  • Osteomyelitis (infection in bones)

  • Intestinal perforation

  • Intestinal hemorrhage

  • Inflammation of the heart muscle (myocarditis)

  • Inflammation of the lining of the heart and valves (endocarditis)

  • Inflammation of the pancreas ( pancreatitis)



Alternative Therapies Of Typhoid Fever

Home Remedies For Typhoid 


1. Banana:
Bananas can bring down the fever and treat diarrhea in people having typhoid. The pectin present in bananas is a soluble fiber that helps absorb liquid in the intestines, thus reducing diarrhea. Moreover, bananas have a high content of potassium that balances the lost electrolyte during diarrhea and fever caused by typhoid.


Tip: Eat 2 to 3 ripe bananas daily until your typhoid symptoms subside.


2. Buttermilk: Drinking buttermilk is another excellent herbal treatment for typhoid fever. It is easy on the stomach and aids in recovery. 


Tip:  Add 2 teaspoons of freshly extracted juice of coriander leaves to 1 cup of buttermilk. Drink this 2 times daily for 1 to 2 weeks.


3. Cloves:
Cloves are also helpful for treating typhoid fever. The essential oils in cloves have antibacterial properties, thus helping in fighting the bacteria triggering typhoid fever.


Tip: Add 5 clove buds in plain water and boil it till it remains half of the initial amount, strain, and drink for at least a week. 


4. Garlic:
The antimicrobial properties of garlic help fight off bacteria that cause typhoid fever. It will also boost your immune system. Moreover, it means that garlic helps eliminate the infection by flushing out and killing the bacteria within your body. 


Tip: Eat 2 garlic cloves on an empty stomach for a couple of weeks to help get rid of typhoid fever symptoms.


5. Basil: Basil is another effective treatment for typhoid fever. This herb has antibiotic, immune boosting, and antibacterial properties that can help get rid of the bacteria that cause typhoid fever.


Tip: Add 20 basil leaves and 1 teaspoon of crushed ginger to 1 cup of water and boil it until the solution reduces by half. Pour a little amount of honey and drink this tea 2 or 3 times a day for a few days.


6. Homemade Oral Rehydration Solution (ORS): Fluid replacement is essential to replenish fluid lost through diarrhea and prevent dehydration. ORS will reduce the intensity of typhoid symptoms and aid recovery.


Tip: Mix ½ small spoon of salt and 6 small spoons of sugar in 4 cups of clean drinking water
and drink this solution until complete recovery.


7. Apple Cider Vinegar (ACV): ACV has acidic properties and is a good home remedy for typhoid fever. It brings down a high fever as it draws out heat from the body of the person suffering from typhoid.

Living With Typhoid Fever

Typhoid if diagnosed and treated timely has a very good prognosis. Make sure to complete your antibiotic course as prescribed by your doctor. 

 

Patients suffering from typhoid fever usually complain about gastrointestinal or digestive problems like loss of appetite. Eating small healthy meals spread out during the day can help in maintaining energy levels.

 

Typhoid disease can also lead to weight loss. Hence a high calorie diet including food like boiled potatoes, sweet potatoes, and bananas can be consumed to help maintain body weight. Also include protein-rich foods such as legumes, cheese, and yogurt in your meals. Avoid meat, spicy food, and deep-fried items as they may be difficult to digest. 

 

High fever and diarrhea are major symptoms of typhoid, and both can lead to dehydration. To maintain the body fluid requirement one should take plenty of fluids like purified water, fresh fruit juices, soups, coconut water etc.

Frequently Asked Questions

References

  1. Overview. Typhoid Fever. National Health Service. September 2021. External Link
  2. Crump JA. Progress in Typhoid Fever Epidemiology. Clin Infect Dis. 2019 Feb 15;68(Suppl 1): S4-S9. External Link
  3. Typhoid. Key Facts.World Health Organization.January 2018 External Link
  4. Bhandari J, Thada PK, DeVos E. Typhoid Fever. 2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan External Link
  5. Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul 8;333(7558):78-82. External Link
  6. Typhoid Fever and Paratyphoid Fever. Symptoms and Treatment. Centers for Disease Control and Prevention. November 2019. External Link
  7. Marinelli F, Tsoucalas G, Karamanou M, Androutsos G. Mary Mallon (1869-1938) and the history of typhoid fever. Ann Gastroenterol. 2013;26(2):132-134. External Link
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