Typhoid (Enteric Fever): Symptoms, Causes, Diagnosis & Treatment

Typhoid (Enteric Fever): Symptoms, Causes, Diagnosis & Treatment

Typhoid Fever is a gastrointestinal infection caused by Salmonella enterica typhi bacteria. It is transmitted from person to person through the fecal-oral route where an infected or asymptomatic individual (who does not exhibit symptoms) with poor hand or body hygiene passes the infection to another person when handling food and water. The bacteria multiply in the intestinal tract and can spread to the bloodstream. Paratyphoid fever, a similar illness, is caused by Salmonella enterica paratyphi A, B, and C.

If someone else eats food or drinks water that’s been in contact with a small amount of infected faeces or urine, they can become unwell with the bacteria and develop typhoid fever.

Typhoid fever is most common in parts of the world that have poor sanitation and limited access to clean water. Worldwide, children are thought to be most at risk of developing typhoid fever. This may be because their immune system (the body’s natural defence against infection and illness) is still developing. But children with typhoid fever tend to have milder symptoms than adults. Typhoid fever is uncommon in the UK, with an estimated 500 cases occurring each year. In most of these cases, the person developed the infection while visiting relatives in Bangladesh, India or Pakistan. But you’re also at risk of developing the infection if you visit Asia, Africa or South America.

Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor. Typhoid fever is endemic in Asia, Africa, Latin America, the Caribbean, and Oceania, but 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam. Within those countries, typhoid fever is most common in underdeveloped areas. Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000 population) and kills an estimated 200,000 people every year.

Self diagnosis – Typhoid fever begins 7-14 days after ingestion of the organism . The fever pattern is stepwise, characterized by a rising temperature over the course of each day that drops by the subsequent morning. The peaks and troughs rise progressively over time.

How does Typhoid affect your body?

Once the bacteria that causes typhoid fever is consumed, it travels from the digestive system into the blood. As the bacteria travel through the body, symptoms like high fever, headache, and overall fatigue can develop. The digestive system is also affected by the bacteria, which leads to stomach pain, diarrhea or constipation, and weight loss. The blood can carry the bacteria to other organs including the lungs, liver, gallbladder, and kidneys. Infections in these organs can cause other problems and symptoms, such as pneumonia.

What are the Causes of Typhoid?

Typhoid is caused by the bacterium Salmonella Typhi. It is the most serious of the Salmonella infections.

Contaminated food or water is most often the source of a Typhoid outbreak.

Contact with a carrier of the bacterium, polluted water, infected food or milk, shellfish harvested from polluted water, or fresh vegetables grown in contaminated soil are all sources of the Salmonella Typhi bacterium.

People who have had Typhoid are “carriers” until the bacteria is completely gone from their body. If they touch food served to other people when their hands are not properly washed, they can spread Typhoid to those who eat the food.

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What are the Risk Factors of Typhoid?

Common risk factors include –

  • Overcrowded living in endemic areas
  • Poor sanitation/untreated water in endemic areas
  • Poor personal hygiene in endemic areas
  • Visiting endemic countries (e.g., Indian subcontinent, Mexico)
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What are the Symptoms of Typhoid?

The symptoms of typhoid fever usually develop 1 or 2 weeks after a person becomes infected with the Salmonella typhi bacteria. The main symptoms of typhoid fever are:

  • Fever,  which can reach up to 39 to 40C
  • A headache
  • General body pain
  • A cough
  • Constipation

Later, as the infection progresses you may lose your appetite, feel sick and have pain in the abdomen and diarrhoea. Some people may develop a rash.

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How is Typhoid Diagnosed?

  • Patient history – Any history of similar infection within the patient’s social circle or family is obtained as are the details of any recent travel to countries where typhoid is prevalent. Endemic areas include countries in Africa, the Indian subcontinent, South East Asia, and South America.
  • Screening for bacteria – Blood, stool and urine samples are collected so they can be checked under the microscope for the presence of Salmonella typhi. However, the bacteria may not always be detected in the early stages of disease and a series of tests may be needed to confirm the diagnosis.
  • Bone marrow test – Testing the bone marrow is a more reliable method for diagnosing typhoid. However, obtaining a bone marrow sample is painful and is therefore avoided if possible.
  • Lab culture – Blood culture is another common method of diagnosis. Blood drawn from the patient is placed on a culture media, which allows any bacteria present to grow and be detected under a microscope. For this test, around 10 to 15 ml of blood is drawn from adults and around 2 to 4 ml is drawn from toddlers and children, as children have a higher concentration of bacteria in their blood. A stool culture may also provide results by allowing the bacteria to grow in a culture media.
  • Antibody test – Serum samples can be tested for antibodies against typhoid. For this test, 1 to 3 ml of blood is collected in a tube that does not contain an anticoagulant so that the clear serum portion of the blood can be separated off and tested for antibody titre.
  • Widal test – The Widal test involves testing for agglutinating antibody levels against O antigens which usually appear 6 to 8 days after disease onset and H antigens which appear on days 10 to 12. However, the use of more recent tests such as the IDL Tubex test and the Typhidot test allows for a more rapid detection of the antibodies, leading to a faster diagnosis.
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How to Prevent & Control Typhoid?

  • Vaccination – There are two types of vaccines available; the inactivated injectable vaccine (lasting 2-3 years) and the live attenuated oral vaccine (lasting 5-7 years). Discuss your best options with your healthcare provider, including revaccination schedules
  • Wash and dry your hands thoroughly after going to the toilet, changing a baby’s nappy or caring for people who are unwell.
  • Do not prepare or serve food for other people if you are unwell.
  • Stay away from work, school, social gatherings if you are unwell.
  • Follow the advice of your public health unit on when you are able to return to work or school. If you work at a job where you handle food, care for small children, you may not be able to work until it is known that you no longer carry any typhoid bacteria.

Treatment of Typhoid Allopathic Treatment

The primary treatment for typhoid, as for most other diarrheal diseases, is oral rehydration solution.

  • Typhoid is also 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.

Treatment of Typhoid Homoeopathic Treatment

Homoeopathic medicines for typhoid are Baptisia, Arnica, Muriaticum Acidum and Arsenic Album. Baptisia is rated among the best Homeopathic medicines for typhoid fever with delirium. It also helps offensive discharge during typhoid fever. Typhoid fever with a sore, bruised feeling all over the body is treated most effectively with Homeopathic medicine Arnica. Muriaticum Acidum is the best medicine for typhoid with involuntary stool and deep sleep while Arsenic Album is recommended as one of the best Homeopathic medicines for typhoid with marked exhaustion, anxiety and restlessness.

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Typhoid – Lifestyle Tips

Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them.

Wash and dry your hands carefully with soap and water after using the toilet, and do not prepare or serve food for other people. This will lower the chance that you will pass the infection on to someone else.

What are Recommended Exercises for Person with Typhoid?

No specific limitations on activity are indicated for patients with typhoid fever. As with most systemic diseases, rest is helpful, but mobility should be maintained if tolerable. The patient should be encouraged to stay home from work until recovery.

Typhoid & Pregnancy – Things to know

A pregnant woman with typhoid runs a huge risk of becoming very weak due to the contraction of the disease. The mother’s body may weaken considerably making it next to impossible to complete the pregnancy. Also, since treatment includes a liquid diet mostly, it has been seen that both the mother and the baby lose out on nutrition.

As far as the baby goes, there is a huge risk of miscarriage if the disease goes untreated. In case the bacteria have reached the baby, there is a good chance that there might be some deformity at birth or the baby may be born prematurely or weigh less.

Common Complications Related to Typhoid

The 2 most common complications in untreated typhoid fever are:

  • Internal bleeding in the digestive system
  • Splitting (perforation) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

Other FAQs about Typhoid

Is Typhoid contagious through kissing?

Many of the members of the bacterial genus Salmonella are contagious. The organisms can be transferred from person to person by both direct (via saliva, fecal/oral spread, kissing) and indirect contact (for example, using contaminated eating utensils).

Is Typhoid deadly?

Typhoid fever is a potentially deadly disease. Typhoid fever is caused by a bacterium, Salmonella typhi. Without treatment, 10%-30% of patients with typhoid fever die, and even with appropriate antibiotics, approximately 1% of patients still die.

What is the normal range for typhoid?

The diagnostic value of the Widal test was assessed in an endemic area. The test was done on 300 normal individuals, 297 non-typhoidal fevers and 275 bacteriologically proven cases of typhoid. Of 300 normal individuals, 2% had an H agglutinin titre of 1/160 and 5% had an O agglutinin titre of 1/160


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