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Typhoid Fever - Symptoms, Complications, Diagnosis, and Treatment

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Typhoid fever is caused by a bacterial infection that affects many organs as it spreads throughout the body. Read the following article to know more.

Written by

Dr. Geethika. B

Medically reviewed by

Dr. Shubadeep Debabrata Sinha

Published At June 29, 2022
Reviewed AtDecember 15, 2023

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.

Is Typhoid Contagious?

Typhoid fever is a contagious disease. It occurs due to the ingestion of contaminated food and water. The other modes of transmission are sharing towels, and utensils, kissing, and hugging.

What Are the Causes of Typhoid Fever?

Typhoid fever is caused by a bacterial strain known as Salmonella enterica serotype typhi. A related illness known as paratyphoid fever is brought on by different strains of the salmonella bacterium. In areas where outbreaks are frequent, people are more likely to contract the bacterium. Those that carry the germs excrete the bacteria in their urine and feces. Bacteria can spread from hands to items or other persons if hands are not well cleaned after using the lavatory. A person who carries the bacterium might potentially spread it. It can contaminate uncooked food, such as unpeeled fresh apples. It is possible to acquire bacteria from sources when water is not treated to eradicate germs. This includes consuming unpasteurized milk or juice, drinking water, or using ice that has been created from untreated water.

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.

  • 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 Is the Normal Range for Typhoid?

Typhoid's normal range is the laboratory values that are associated with the bacterial infection caused by Salmonella typhi. The test that describes the typhoid range is the widal test. This test is used to diagnose typhoid fever. The results are reported in the form of titers. The antibody titer of the O antigen is more than 1:160. It indicates acute infection. The antibody titer of the H antigen is more than 1:160. It indicates recovery stage, past infection, or immunized stage. The typhoid normal range for O and H antigens is less than 1:160. This is considered a negative result.

How Is Typhoid Fever Diagnosed?

The diagnostic steps are as follows:

  • 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.

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.

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 percent), 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 Hot Food: 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 Are The Signs Of Recovery From Typhoid?

The signs of recovery from typhoid are as follows:

  • Appetite gets restored.

  • No fever.

  • Diminished fatigue.

  • No chest congestion.

  • No body aches and stomach aches.

  • Diminished diarrhea.

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.

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 chance for the patients to develop complications. If the infection is not completely cured, the symptoms may reappear.

Frequently Asked Questions

1.

How Long Does It Take To Cure Typhoid Fever Completely?

With appropriate treatments and care, typhoid fever usually improves in three to five days. However, not getting proper treatment can worsen the symptoms and even cause some life-threatening complications.

2.

What Is the Best Treatment for Typhoid?

Treatments with antibiotics like Ciprofloxacin (in non-pregnant patients), Azithromycin, and Ceftriaxone are the most effective treatment methods for typhoid fever.

3.

Can a Person Suffering From Typhoid Fever Drink Milk?

Yes, it is safe for a person with typhoid to drink milk. However, the person needs to take the prescribed antibiotics to better the condition.

4.

Which Organs Are Affected by Typhoid?

After the occurrence of the infection, the bacteria causing typhoid fever reach various organs of the body via the bloodstream. As a result, the gastrointestinal tract, liver, spleen, kidneys, etc., are usually affected.

5.

What Food Is Good to Take During Typhoid Fever?

It is important to nourish your body with highly nutritious fruits and cooked vegetables during typhoid fever. Also, drink lots of water and fresh fruit juices to stay hydrated during typhoid fever.

6.

Can Typhoid Cure Itself Without Any Treatments?

Some healthy individuals have usually cured typhoid entirely within a few weeks. However, getting an antibiotic therapy prescribed by a doctor is crucial for treating typhoid fever; if left untreated, it can cause severe life-threatening problems in some.

7.

What Foods Must Be Avoided During Typhoid Fever?

Eating highly nutritious cooked vegetables and some fruits like ripe bananas is essential. However, the following foods must be avoided until a person is completely cured of typhoid.
- Raw vegetables and salads that contain broccoli, onions, etc.
- Berries.
- Nuts like almonds, pistachios, and walnuts.
- Seeds like pumpkin seeds, chia seeds, and flax seeds.
- Deep-fried foods include fried chicken, potato chips, and processed foods.
- Spicy foods.

8.

What Are the Common Antibiotics Used in Treating Typhoid Fever?

The most common antibiotics used in treating typhoid fever are,
- Cephalosporins.
- Azithromycin.
- Ampicillin.
- Chloramphenicol.
- Cotrimoxazole.

9.

Does Typhoid Spread by Kissing?

No, typhoid does not spread through kisses or hugs. So, it is safe for someone with typhoid to go to gatherings.

10.

Does Typhoid Affect the Eyes?

The eye involvement of typhoid is not very common. However, rarely, untreated typhoid may lead to eyelid edema or abscess, vitreous hemorrhage, retinal hemorrhage, corneal ulceration, etc.

11.

Can Typhoid Fever Cause Cough or Breathlessness?

Typhoid fever can cause a person to feel very tired and unwell. Some of the common symptoms are cough, breathlessness, and fatigue.

12.

Can a Typhoid Fever Occur Again After Recovery?

Typhoid relapses may occur after the completion of the antibiotic course. However, typhoid fever relapses are not very common.

13.

What Are the Common Symptoms of Typhoid?

Following are the common signs and symptoms of typhoid,
- Fever.
- Stomach pain.
- Swollen stomach.
- Diarrhea or constipation.
- Headaches.
- Muscle fatigue or body pain.
- Sweating.
- Loss of appetite.
- Weight loss.
- Rashes.
- In severe untreated cases, typhoid may cause severe symptoms related to meningitis, jaundice, kidney failure., etc.

14.

Is Typhoid Hepatitis Common?

Typhoid hepatitis is a rare manifestation of typhoid. When a person with typhoid experiences hepatomegaly (swollen liver) or jaundice, the person is suspected of developing typhoid hepatitis.

15.

Which Vaccine Is Suitable for Typhoid?

Parenteral Vi Polysaccharide and oral Ty21a are suitable for typhoid vaccinations. These can be administered in adults and children above the age of two years.

16.

What Are the Stages of Typhoid Fever?

Typhoid fever occurs in the following four stages, namely,
First Stage: Here, the person infected experiences mild symptoms like dry cough or headache.
Second Stage: Following the first stage, the person experiences stomach bloating and raised body temperature.
Third Stage: If left untreated, the person affected may experience more severe problems like intestinal perforations and abdominal bleeding. The person becomes extremely weak in this stage where they find it hard to stand up or walk, and they become highly dehydrated, which worsens the delirium (confusion).
Fourth Stage: If not treated properly, the person experiences severe life-threatening complications like meningitis, kidney failure, pneumonia, etc.

17.

Which Organism Causes Typhoid?

Typhoid is caused due to a bacteria called Salmonella typhi. The bacteria Salmonella paratyphi causes paratyphoid fever. Also, typhoid fever usually spreads via the orofecal route, where the person can spread the bacteria if they do not wash their hands properly with soap after defecating.
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Dr. Shubadeep Debabrata Sinha
Dr. Shubadeep Debabrata Sinha

Infectious Diseases

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