Typhoid Fever Causes, Symptoms & Treatment

The Facts on Typhoid:

  • Typhoid, also known as typhoid fever or enteric fever.
  • Typhoid fever is caused by Salmonella typhi bacteria.
  • Typhoid fever is rare in industrialized countries.
  • However, it remains a serious health threat in the developing world, especially for children.
  • Typhoid is usually curable, but some bacterial strains are becoming increasingly resistant to antibiotics.
  • If untreated, about 10% to 16% of people with typhoid will die. This drops to less than 1% when people aretreated promptly.
  • Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected.
  • Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
  • Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications.
  • Vaccines against typhoid fever are available, but they’re only partially effective.
  • Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Causes of Typhoid:

  • Typhoid is usually transmitted by water or food, in much the same way as cholera.People who are infected excrete live bacteria in their feces and urine. They are usually contagious for a few days before any symptoms develop, so they don’t know they need to take extra precautions. If they don’t wash their hands properly, the typhoid bacillus can be transferred to food or water and from there to another person. Also, it can be spread directly from person to person via contaminated fingers.
  • About 3% of infected people (treated or not) become asymptomatic carriers ofSalmonella typhi. This means that they continue to shed bacteria in their feces for at least a year and often for life but don’t have any symptoms of typhoid. There are a small number of typhoid carriers in every country.
  • Typhoid fever is caused by virulent bacteria called Salmonella typhi (S. typhi). Although they’re related, S. typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, aren’t the same.

Symptoms:

Symptoms usually appear 1 or 2 weeks after infection but may take as long as 3 weeks to appear. Early symptoms include fever, general ill-feeling and abdominal pain. High fever (103°F, or 39.5°C) or higher and severe diarrhea occurs as the disease gets worse.

Some people with typhoid fever develop a rash called “rose spots,” which are small red spots on the abdomen and chest.

Other symptoms that occur include:

  • Abdominal tenderness
  • Agitation
  • Bloody stools
  • Chills
  • Confusion
  • Difficulty paying attention (attention deficit)
  • Delirium
  • Fluctuating mood
  • Hallucinations
  • Nosebleeds
  • Severe fatigue
  • Slow, sluggish,lethargicfeeling
  • Weakness
  • With antibiotic treatment, symptoms start to subside after 5 to 7 days,but without treatment they continue to get worse for several weeks, and more than 10% of untreated people may die.
  • A small number of people who recover from typhoid may have a relapse of their symptoms just a few weeks later. The second bout tends to be less severe than the first, and clears up quickly with further treatment.
  • Many people suffer from mild intestinal bleeding, but it is severe in only a small minority of cases. The main way typhoid kills is by causing perforation of the small intestines, causing bacteria to pour into the abdominal cavity. This condition is calledperitonitis, and is often fatal.
  • Other complications of typhoid occur when a large number of bacteria get into the bloodstream, causingbacteremia. They can travel to the lungs, causing pneumonia, or to the lining of the brain (meningitis), the bones (osteomyelitis), the heart valves (endocarditis), the kidneys (glomerulonephritis), the genital or urinary tract, or the muscles. Hepatitis (inflammation of the liver) can also occur.

Diagnosing Typhoid:

Your doctor will ask you about your symptoms and perform a physical examination. If your doctor suspects typhoid fever, it is diagnosed by culturing a blood or stool sample and, in rare instances, bone marrow. A blood test that checks for antibodies can be used to make a diagnosis. However, this test is not very accurate. Your doctor may do other tests to rule out other conditions that cause symptoms similar to typhoid.

Exams and test:

complete blood count (CBC) will show a high number of white blood cells.

blood culture during the first week of the fever can show S. typhibacteria.

Other tests that can help diagnose this condition include:

  • ELISA urine test to look for the bacteria that cause Typhoid fever
  • Fluorescent antibody study to look for substances that are specific to Typhoid bacteria
  • Platelet count(platelet count may be low)
  • Stool culture 

Treatment:

Typhoid is treated with antibiotics (e.g., ceftriaxone, levofloxacin, ciprofloxacin),* which usually clear up symptoms in less than a week. People with severe typhoid also may be treated with glucocorticoids such as dexamethasone.

Very few people die of typhoid if they are properly treated. However, they are likely to be infectious for at least a week after symptoms pass. Some people remain infectious, excreting the organisms in the stool, for 3 months or more. The long-term carrier state is unlikely to occur except for those with gallbladder disease.

Careful hand-washing after bowel movements and prior to food handling will help prevent the spread of typhoid. Carriers may be treated with antibiotics for 4 to 6 weeks.

Typhoid fever can be acquired almost anywhere in the world, but it is very rare in developed countries. You have a higher risk of getting typhoid fever if you travel to developing areas such as Asia, Africa, and Latin America. 

Prevention:

Preventing typhoid is all about avoiding contaminated food and water. The same healthy practices will also help protect you from diseases such as cholera and hepatitis A, which are transmitted in the same way. Follow these guidelines to minimize your risk:

  • Boil or disinfect all water before drinking it – use disinfectant tablets or liquid available in pharmacies or drink commercially bottled (preferably carbonated) beverages.
  • Peel all fruit and vegetable skins before eating.
  • Keep flies away from food.
  • Watch out for ice cubes, ice cream, and unpasteurized milk, which can easily be contaminated.
  • Cook all food thoroughly and eat it while it’s hot.
  • Be aware of the “danger foods” – shellfish, salads, and raw fruit and vegetables.
  • Do not eat food or drink beverages from street vendors.
  • At present, vaccinations against typhoid provide about 50% protection for 3 to 7 years– the duration of protection depends on the vaccine used. The vaccine is available as an oral capsule and as an injection. Your doctor will determine what form is best for you or your children. Even vaccinated people must follow the food safety tips listed above. It is best to be immunized at least 7 to 14 days before possible exposure (depending on the vaccine used).

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