Typhoid fever

Symptoms of Typhoid

Typhoid fever is a bacterial infection that primarily affects the intestines. Symptoms typically appear 10–14 days after exposure and develop gradually. The onset is often subtle but can become severe if left untreated.

The hallmark symptom of typhoid is prolonged high fever, which has a distinctive pattern:

• The fever develops slowly over several days, unlike the sudden spikes seen in other infections.
• It rises in a stepwise fashion, increasing a little each day until it peaks.
• The temperature may climb as high as 104.9°F (40.5°C).
• Once established, the fever remains consistently high and is typically continuous, not intermittent.
• Without treatment, the fever may persist for several days to weeks.
  
  

Other common signs and symptoms that may accompany fever include:

• Headache
• Abdominal pain
• Tiredness and weakness
• Muscle aches
• Loss of appetite
• Constipation or diarrhea
• Confusion
• Low pulse rate 
• Rose-colored spots on the neck, chest, or abdomen
• Swollen abdomen
  
  

As the illness progresses, some patients may enter the "typhoid state"—a condition marked by extreme exhaustion, where the person lies still with half-closed eyes and shows minimal responsiveness.

If untreated, typhoid can lead to life-threatening complications such as intestinal perforation and internal bleeding.

Causes Of Typhoid

Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi (commonly known as Salmonella Typhi).

How is typhoid fever transmitted?

1. Fecal-oral route (primary cause)

• Typhoid fever is most commonly spread through the fecal-oral route, meaning the bacteria are passed in the feces of an infected person and then ingested by another person.
  
  
• This can happen when a person eats food or drinks water that has been contaminated with feces or urine from someone infected with Salmonella Typhi.
  
  

2. Contaminated food and water

Typhoid fever is primarily spread through contaminated food and water, particularly in regions with poor sanitation. Common sources include:

• Contaminated water: Drinking untreated water or consuming food prepared with it.
• Raw or undercooked food: Often from regions with inadequate food safety standards.
• Ice: Made from untreated or contaminated water.
• Raw fruits and vegetables: Washed with contaminated water or grown in contaminated soil.
• Street food and unpasteurized dairy: Common in endemic areas with poor hygiene practices.

3. Poor hygiene and sanitation

• Poor sanitation, such as the absence of clean toilets or sewage systems, increases the likelihood of contamination.

• Improper hand hygiene, especially after using the toilet or handling food, can lead to the spread of bacteria.
  
  

4. Close contact with infected individuals

• Close contact with an infected person, especially in crowded or unsanitary environments, can spread the bacteria.

• People who are chronic carriers (those who have had typhoid fever but continue to shed the bacteria in their stool or urine) can unknowingly spread the infection to others.

Risk Factors For Typhoid

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

Living in or traveling to endemic areas

• Typhoid is most common in areas with poor sanitation and limited access to clean water, including parts of Asia, Africa, and Latin America.
  
  

Poor sanitation and hygiene

• Areas lacking proper sewage systems, clean water, and hygienic food handling are at high risk.

• People living in environments with inadequate sanitation are more likely to be exposed.
  
  

Contaminated water and food sources

• Unclean drinking water, particularly in rural or underdeveloped areas, is a major risk factor.

• Consumption of raw or undercooked food, especially from street vendors or restaurants with poor food handling practices, increases risk.
  
  

Close contact with infected individuals

• Household contacts or caregivers of someone who has active typhoid fever or is a chronic carrier of the bacteria.

• People who have had typhoid but continue to shed the bacteria in their urine or stool without symptoms (asymptomatic carriers) can unknowingly spread it.

Overcrowded living conditions

• Living in overcrowded conditions with shared toilets (e.g., slums or refugee camps) increases exposure risk.

Children and young adults

• Children are at higher risk, as they are more likely to engage in poor hygiene practices.

• Young adults traveling to endemic areas may also face increased exposure.
  
  

Immunocompromised individuals

• People with weakened immune systems (due to conditions like HIV/AIDS, cancer, or immunosuppressive treatments) are more susceptible to infections like typhoid.

Health care workers

• Healthcare workers are at high risk of typhoid due to close contact with infected patients, handling contaminated medical equipment, and exposure to fecal matter in environments with inadequate sanitation and hygiene.

Diagnosis Of Typhoid

Typhoid fever is diagnosed through a combination of clinical evaluation and laboratory tests to detect the presence of Salmonella Typhi bacteria.

1. Clinical evaluation

Doctors begin by asking about your symptoms and performing a physical examination. Signs like abdominal tenderness, enlarged liver or spleen, swollen lymph nodes, and a rash called rose spots may be present. However, these signs can look similar to other illnesses, so lab tests are essential for confirming typhoid fever.

2. Laboratory tests

a) Blood culture

• This is the most reliable in the first week of illness. It detects the presence of Salmonella Typhi in the bloodstream.
  
  

b) Widal test

• This test is done in two ways: Widal slide agglutination and Widal tube agglutination.

• It detects antibodies (agglutinins) against S. Typhi.

• While this test is widely used, but less specific and prone to false positives/negatives.
  
  

c) Stool and urine culture

• May detect the bacteria after the first week of illness.

• It is useful in identifying chronic carriers.
  
  

d) Bone marrow culture

• The most sensitive test, especially when antibiotics have already started.

• It can detect bacteria even in late stages of illness.

e) Typhidot test

• It is a rapid serological test used to detect antibodies against Salmonella Typhi.

• IgM antibodies indicate recent or current infection, while IgG antibodies suggest past exposure or infection.

• Useful for early diagnosis, even before cultures become positive.
  
  
  

3. Imaging tests

• If complications are suspected, an Ultrasound or CT scan may help detect intestinal perforation, abscesses, or hepatosplenomegaly (enlarged liver/spleen).
  
  

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Prevention Of Typhoid

Typhoid fever can be prevented through vaccination, clean water, safe food, and good hygiene. Follow these simple steps to protect yourself and others:

1. Drink safe water

• Always drink boiled, bottled, or filtered water.

• Avoid ice unless made from safe water.

• Use clean water for brushing teeth and washing fruits and vegetables.

2. Eat safe food

• Eat thoroughly cooked food.

• Avoid raw fruits and vegetables unless cleaned and peeled under hygienic conditions.

• Be cautious with street food, especially in areas with poor sanitation.

• Avoid milk and dairy products that may be adulterated with contaminated water.

3. Practice good hygiene

• Wash hands with soap and water:

  • Before eating or cooking.

  • After using the toilet.

• Use hand sanitizer if soap isn’t available.

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4. Improve sanitation

• Dispose of human waste properly.

• Keep surroundings clean and promote public health education.

• Ensure communities have access to safe water and toilets.

5. Get vaccinated

Typhoid vaccination is recommended for:

• Travelers to typhoid-endemic regions

• Household contacts of typhoid carriers

• Healthcare workers at risk of exposure

• People living in areas with endemic areas with poor sanitation

• Those in group housing (e.g., dormitories, camps)

• Immunocompromised individuals at risk of severe illness.

Note: Talk to your healthcare provider to explore your vaccination options and schedule. Along with vaccination, practicing good hygiene and food safety is crucial for added protection.

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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

A pediatrician provides expert diagnosis and treatment of typhoid in children, ensuring age-appropriate care.

An internal medicine specialist manages typhoid in adults with a focus on comprehensive care and symptom control.

An infectious disease specialist offers advanced care for complicated or drug-resistant typhoid cases.

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Treatment Of Typhoid

1. Antibiotic therapy

Antibiotics are the first line and only effective treatment option for typhoid fever. The following have been traditionally used for the treatment of typhoid. However, they are increasingly met with antibiotic resistance:

• Ciprofloxacin
• Amoxicillin
• Trimethoprim-sulfamethoxazole
• Chloramphenicol

Due to the emergence of antibiotic-resistant strains, the newer drugs of choice include:

• Azithromycin
• Ceftriaxone
• Meropenem

2. Supportive care

• Hydration: Ensuring proper hydration is crucial, particularly in cases of diarrhea.

• Electrolyte balance: Maintaining proper electrolyte levels, especially in severe diarrhea cases, is essential.

• Symptom management: Analgesics and antipyretics like paracetamol (acetaminophen) may be used for managing fever and pain during typhoid.

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Home Care For Typhoid

While medical supervision is essential, especially for moderate to severe cases, mild typhoid can sometimes be managed at home with supportive care and doctor-prescribed medications.

1. Follow the prescribed medications

• Take all medications as prescribed by your doctor — even if symptoms improve early

• Do not self-medicate; improper use can lead to resistance or relapse

2. Ensure proper hydration

• Drink plenty of clean, boiled, or filtered water

• Oral rehydration solution (ORS), clear soups, and coconut water can be consumed
  
  

3. Consume a light, nutrient-dense dense and hygienic diet

Foods to eat:

• Easily digestible carbohydrates like white rice, boiled potatoes, plain toast, soft chapatis, porridge, or semolina (suji)

• Boiled or steamed Vegetables like carrots, pumpkin, bottle gourd (lauki), and zucchini—well-cooked and mashed

• Fruits like bananas, stewed apples, papaya, and ripe mangoes.

• Protein, like soft-boiled eggs, mashed lentils (dal), and well-cooked chicken, in moderation

• Dairy products like curd/yogurt and buttermilk
  
  

Foods to avoid:

• Fried, spicy, or oily foods

• Raw vegetables or salads

• High-fiber foods like whole grains

• Carbonated drinks and caffeine

• Pickles and fermented items

• Red meat and heavy dairy

4. Maintain good hygiene

• Wash hands thoroughly after using the toilet and before meals

• Disinfect commonly touched surfaces

• Use separate utensils and towels for the patient
  
  

5. Rest and monitor symptoms

• Ensure adequate bed rest to support recovery

• Carefully monitor your symptoms.

Stay in regular contact with a doctor if any new or worsening symptoms appear during treatment or recovery at home.

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Complications of Typhoid

Typhoid fever, if left untreated or inadequately treated, can lead to several serious complications. Here are some of the complications associated with typhoid fever:

• Intestinal perforation: One of the most serious complications, it occurs when the bacteria cause ulceration in the intestinal walls, leading to a hole or perforation. This can result in the leakage of intestinal contents into the abdominal cavity, causing peritonitis (infection of the lining of the abdominal cavity).
  
  

• Internal bleeding: Ulceration caused by the bacteria can lead to bleeding in the intestines.
  It can result in significant blood loss and, in severe cases, shock.
  
  

• Sepsis: The bacteria Salmonella Typhi can enter the bloodstream, leading to a systemic infection known as sepsis. Sepsis can lead to organ failure, shock, and death if not treated immediately.
  
  

• Neurological complications: In rare cases, typhoid fever can cause encephalitis  (inflammation of the brain) or other neurological symptoms. This can lead to confusion, delirium, and even coma.
  
  

• Liver or gallbladder issues: Typhoid fever can cause liver inflammation or gallbladder issues. Inflammation may lead to jaundice (yellowing of the skin and eyes).
  
  

• Kidney problems: Typhoid fever can affect kidney function, leading to acute kidney failure in severe cases.
  
  

• Pneumonia and respiratory issues: Typhoid fever can also cause pneumonia, particularly in older adults or those with weakened immune systems.
  
  

• Heart problems: In rare cases, the infection may affect the heart, causing inflammation of the heart muscle (myocarditis) or infection of the heart lining (endocarditis).

• Bone and joint complications: Bone complications of typhoid fever, though rare, include osteomyelitis and septic arthritis. These occur when Salmonella Typhi spreads to bones or joints, leading to pain, swelling, and potential long-term damage.