Typhoid Fever: Causes, Symptoms, Treatment, and Prevention

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Young Asian woman have a fever lying on sofa while her husband

Ever heard about Salmonella typhi, a sneaky bacteria that can bring about a serious illness known as typhoid fever? It usually happens in regions where access to clean water and proper sanitation is insufficient.

Learn about its symptoms, stages, and how to stay safe in our easy-to-understand guide. Get to know how this illness spreads, the importance of washing hands, and simple steps to prevent it.

What is typhoid fever?

Typhoid fever, also called enteric fever, is a serious illness caused by bacteria known as Salmonella typhi. It mainly affects the intestine and tends to occur in areas with poor sanitation and limited access to clean water. The main way it spreads is through the consumption of water and food that has been contaminated by faecal matter.

Is typhoid fever fatal?

Typhoid fever can be life-threatening if left untreated, but the majority of cases can be successfully treated with antibiotics. Approximately 1% to 2% of cases result in death.

What are the symptoms of typhoid fever ?

You might start noticing symptoms slowly, typically 1 to 3 weeks after getting exposed to the bacteria. The symptoms of typhoid include:

  • Fever, which rises and falls alternatively
  • Headache
  • Nausea
  • Abdominal pain
  • Loss of appetite
  • Diarrhoea or constipation
  • Weakness
  • Dizziness
  • Cough
  • Muscle aches
Typhoid Fever

How is typhoid fever transmitted?

Typhoid fever is mainly transmitted by:

  • Contaminated water and food: The most common transmission occurs through the consumption of water or food contaminated with faecal matter containing the Salmonella typhi bacteria.
  • Undercooked food: Consuming inadequately cooked or raw food, particularly those prepared by contaminated hands or in unhygienic conditions.
  • Fomites of infected patients: Contact with objects or surfaces touched by individuals carrying the bacteria (fomites).
  • Person-to-person transmission: Direct transmission can occur when an infected person passes on the bacteria to another individual, making personal contact a potential source of infection.

What are the stages of typhoid fever?

Stage 1: Early symptoms (Days 5-14):

  • Fever begins gradually, increasing in steps.The fever in typhoid is called step-ladder fever. (It rises one day and falls on the next day and continues to rise and fall in this pattern)
  • Bacteria enter the bloodstream.

Stage 2: Second week of fever:

  • Bacteria multiply in a part of your immune system called Peyer’s patches.
  • Abdominal pain, diarrhoea, or constipation develop.

Stage 3: Severe complications (third week):

  • Without treatment, severe damage can occur.
  • Complications like internal bleeding and encephalitis may arise.

Stage 4: Recovery (after third week):

  • A high fever starts to decrease.
  • Even after feeling better, bacteria may persist in the gallbladder, making you contagious.

What is the risk group for typhoid?

Typhoid is more severe in:

  • People who live in close contact with someone who has been diagnosed with typhoid, particularly in households.
  • People visiting or residing in regions with poor sanitation and have limited access to clean water.
  • People with weakened immune systems, such as those with HIV/AIDS or undergoing certain medical treatments, are more susceptible to severe complications from typhoid.
  • Those working in laboratories handling the Salmonella typhi bacteria may be at risk of accidental exposure.

How is typhoid fever diagnosed?

The diagnosis of typhoid is based on the clinical symptoms, signs and diagnostic test results. Your doctor will ask about your symptoms, perform a physical examination and do some tests.

The diagnostic tests include:

  • Blood culture: It is a commonly performed test to detect IgM and IgG antibodies and is usually non-expensive. A blood sample is taken to find the bacteria causing typhoid.
  • Stool and urine culture: Your healthcare provider collects stool and urine samples to detect bacteria.
  • Widal test: This test identifies antibodies through slide or tube agglutination methods. It becomes more reliable after the second week of symptoms.
  • Bone marrow culture: This test is not routinely performed and is expensive.
  • PCR assay: Polymerase Chain Reaction (PCR) is a molecular test that examines specific genes in bacteria.
  • ELISA: An Enzyme-Linked Immunosorbent Assay (ELISA) is used to detect antibodies or antigens in the blood.

What is the treatment for typhoid fever?

  • The primary and effective treatment for typhoid fever involves antibiotics. The specific antibiotics prescribed depend on the type of bacteria causing the infection.
  • If typhoid is detected early and symptoms are mild, you can be treated at home with a 7-14-day course of antibiotics. However, if you are in a severe condition or experiencing complications, additional interventions may be necessary. In such cases, hospitalisation is likely required for appropriate treatments.
  • You may start feeling better within a few days, but it is important to continue taking medicines as prescribed by your doctor because bacteria still remain in the body for some days after the treatment.

What medications are prescribed for the treatment of typhoid?

You may be prescribed following antibiotics for typhoid treatment, depending on the severity of the disease:

  • Ciprofloxacin
  • Amoxicillin
  • Trimethoprim-
  • Sulfamethoxazole
  • Chloramphenicol

Before taking any medicine, always consult with your doctor.

If you are pregnant, make sure to let your doctor know, because chloramphenicol is not recommended for pregnant women.

Will I stay contagious after recovering from typhoid fever?

Some individuals can remain contagious even after their symptoms have resolved. Approximately 5% of people who recover from typhoid fever become long-term carriers and can still spread the bacteria.

What vaccines are available for typhoid fever in India?

In India, there are two main types of vaccines to protect you against typhoid fever:

  • Typhoid Polysaccharide Vaccine is recommended for individuals aged two years and older, administered as a one-time shot given into the muscle (intramuscular injection).
  • Typhoid Conjugate Vaccine (TCV) is suitable for kids aged 6 months and older,administered as a single dose injected into the muscle (intramuscular injection).

The Indian Academy of Pediatrics advises the administration of the typhoid vaccine to all children starting from 9 months of age. The age limit varies with the type of vaccine.

It is important to note that while typhoid vaccines offer protection, they are not 100% effective and may require booster doses to maintain immunity over time. So, even after getting vaccinated, it is important to practise good hygiene and avoid contaminated food and water to stay safe from typhoid fever.

When should I get a typhoid vaccine?

If you are planning to travel to places where there is a risk of typhoid fever, it is important to get vaccinated at least two weeks before your trip. This helps your body to build protection against the illness.

Also, depending on how long you will be staying and the type of vaccine you get, you might need booster shots. Boosters are like friendly reminders for your immune system to stay strong and keep you safe from typhoid.

Are there any side effects from vaccines?

After receiving the typhoid vaccine, it is common to experience some mild side effects. These may include a slight fever, redness, swelling, and pain at the injection site. These reactions are generally mild and temporary, indicating that your body is responding to the vaccine and building protection against typhoid.

Is there a possibility of getting infected again after the initial infection?

Yes, you can get typhoid fever again. Even if you have had it before or have gotten a vaccine, your protection may not last forever. Factors like different types of bacteria, carriers spreading it, and travelling to certain places can increase the chance of getting sick again. It commonly occurs around a week after completing the course of antibiotics, but it might happen weeks or months later in certain cases. The symptoms are expected to be less severe compared to the initial occurrence.

What are the complications of typhoid?

Typhoid can lead to various complications, including:

  • Typhoid encephalopathy (affecting the brain)
  • Myocarditis (heart inflammation )
  • Nephritis (kidney inflammation)
  • Internal bleeding in the digestive system
  • Bone and joint infection (especially in children with sickle cell anaemia,
  • hemoglobinopathies, and preexisting bone disease)
  • Pneumonia (lung infections)
  • Hepatitis (liver inflammation)

How long does typhoid fever last?

Typhoid fever typically lasts 7 to 10 days with appropriate treatment. However, without treatment or delayed treatment, it can persist for three weeks or longer.

Which home remedies can be used in addition to typhoid medications?

When dealing with typhoid, alongside your medications, you can try the following home remedies:

  • Drink plenty of fluids like water, oral rehydration solutions, and clear broths to stay hydrated.
  • Consume easily digestible foods such as rice, bananas, and boiled vegetables to provide essential nutrients.
  • Opt for mild and non-spicy foods to ease digestion and prevent irritation.
  • To relieve fever and discomfort, apply cold compresses to your forehead and body.
  • Practise good hygiene to prevent the spread of infection, including regular handwashing.

By following these steps, you can support your recovery and increase the effectiveness of your medications.

How do I prevent typhoid fever?

To prevent typhoid fever:

  • Wash your hands thoroughly with soap and water, especially before eating, after using the toilet, and after touching contaminated surfaces.
  • Avoid consuming raw or undercooked food. Opt for thoroughly cooked food, particularly meat and eggs.
  • Use proper sanitation facilities, and avoid open defecation. Ensure the proper disposal of sewage and waste.
  • Avoid raw milk and items prepared from raw milk. Consume only pasteurised or boiled milk
    Consume purified water by boiling it or using a disinfectant.
  • Thoroughly wash fruits and vegetables, especially if eaten raw. If possible, consider peeling them.

References:

  1. Mukhopadhyay B, Sur D, Gupta SS, Ganguly NK. Typhoid fever: Control & challenges in India. Indian J Med Res. 2019 Nov;150(5):437-447. doi: 10.4103/ijmr.IJMR_411_18. PMID: 31939387; PMCID: PMC6977362.
  2. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002 Nov 28;347(22):1770-82. doi: 10.1056/NEJMra020201. PMID: 12456854.
  3. https://www.cdc.gov/typhoid-fever/symptoms.html
  4. https://www.who.int/news-room/fact-sheets/detail/typhoid
Ashvini
WRITTEN BY

Ashvini

A medical writer with a Bachelor's degree in Pharmacy who eloquently explores various aspects of medicine and science. Discover her insightful contributions and writings covering a spectrum of healthcare topics.

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