Typhoid Fever - Symptoms, Complications, Diagnosis, and Treatment

What Is Typhoid Fever?

Typhoid fever is caused by the bacteria Salmonella typhi, usually through ingestion of contaminated food or water. Once infected, these people can easily spread the infection to others. The bacteria can stay on the infected patient’s hands for long. Hence, the patient can contaminate everything, including food and drinks, by touch. In places with poor sanitation, water that is used to prepare food and beverages gets contaminated, thus causing infection to individuals who consume it and making them sick. These patients may develop a fever, cough, weakness, headache, stomach pain, diarrhea or constipation, and loss of appetite. Certain patients show internal bleeding, and death occurs in rare instances.

What Are the Symptoms of Typhoid Fever?

The main symptoms of typhoid fever are:

• A persistent high temperature that can reach as high as 104 degrees Fahrenheit.

• Headache.

• Confusion, agitation, and hallucinations.

• General aches and pains.

• Extreme tiredness (fatigue).

• Chills.

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• Cough.

• Constipation.

• Bloody stools.

As the infection progresses, there might be an associated loss of appetite, increased fatigue, stomach pain, and diarrhea. Few patients present with a characteristic rash on the chest and abdomen. These small, flat red spots are called “rose spots.” If the symptoms are left untreated, they will continue to get worse over time and increase the risk of developing potentially fatal complications.

What Are the Complications of Typhoid Fever?

Complications that occur due to typhoid fever usually happen in patients who have not been given timely treatment with appropriate antibiotics or those who did not receive treatment at all.

Under these circumstances, the patients experience complications, which usually develop during the third week of infection.

The two most common complications that are seen in untreated typhoid fever are:

• Internal bleeding in the digestive system.

• Splitting or perforation of a section of the digestive system or bowel. This further spreads the infection to nearby tissues.

How Is Typhoid Fever Diagnosed?

• Patient History: Typhoid fever is diagnosed based on the symptoms and medical and travel history.

• Blood Culture: A confirmation of the diagnosis is based on identifying Salmonella typhi in blood culture or other body fluids or tissues. The most common test to confirm the diagnosis of typhoid is by performing a bacterial culture. The sample (blood, bone marrow, stool, or urine) is placed on a special culture medium that encourages the growth of bacteria. The culture media is then checked for the presence of Salmonella typhi under the microscope. Bone marrow culture is the most sensitive test for this organism.

• Complete Blood Count (CBC): A CBC test will show an elevated number of white blood cells and a lesser number of platelets.

• Antibody Tests: Enzyme-linked immunosorbent assay (ELISA) test can be performed to identify the antibodies to Salmonella typhi bacteria. A fluorescent antibody study can be performed to identify substances that are specific to the Salmonella typhi bacteria.

How Can Typhoid Fever Be Prevented?

Currently, two vaccines are available for typhoid in the United States. They are:

• Pill Vaccines: Pill vaccines are for people six years or older and are given orally as four capsules which are taken every other day. These pills are taken at least one week before traveling to a typhoid-prone area.

• Shot Vaccines: A single-shot vaccine can be given to people who are two years or older. The shot vaccine (or a booster shot) is to be taken at least two weeks before travel.

Neither the pill nor the shot vaccine offers complete protection against typhoid infection (50 % to 80 %), and both vaccines lose their effectiveness over time. As there is no complete protection against the disease, it is of utmost importance to follow the below preventive methods, especially if traveling:

• Washing Hands: Washing hands frequently with hot and soapy water is the best way to control the infection. It is advisable to use hot water with soap and scrub properly for at least 30 seconds. This practice must be followed, especially before eating and after using the toilet. In the absence of hot and soapy water, an alcohol-based hand sanitizer can be used.

• Avoid Consuming Untreated Drinking Water: Typhoid can easily spread through contaminated drinking water in areas where typhoid fever is endemic. Hence it is advisable to drink only bottled or boiled water.

• Avoid Eating Raw Fruits and Vegetables: Raw fruits and vegetables may have been washed in infected water and served as food. Hence avoiding raw foods entirely is a good idea.

• Consume Food That Is Hot: It is best to avoid food that is stored or served at room temperature. Having cooked and steamed food is the best. Avoid street foods.

What Is the Treatment for Typhoid Fever?

Antibiotic therapy is the most effective treatment for typhoid fever. Antibiotics like Ciprofloxacin (Cipro), Azithromycin (Zithromax), and Ceftriaxone are given to kill the bacteria. However, they may cause side effects, and long-term usage can lead to the development of antibiotic-resistant bacteria. Fluids and electrolytes can be administered through the intravenous (IV) route, or water with electrolyte packets can be given.

Diligently following these methods may be beneficial for the patients while recovering from typhoid fever:

• Taking Antibiotics: It is important to follow the doctor’s prescription and complete the entire course of the medication.

• Avoid Cooking and Handling Food: The patients must avoid preparing food for others as they may spread the infection to others. Patients are not allowed to go to work until they completely recover from the disease.

Conclusion:

People traveling to typhoid-prone regions must take utmost care to prevent contracting the infection. Recognizing the symptoms at an early stage and following medical advice diligently will render the patient healthy earlier. The symptoms usually recede in two to four weeks with proper treatment. If the treatment is delayed, there are high chances for the patients to develop complications. If the infection is not completely cured, the symptoms may reappear.