Typhoid Fever Symptoms, Causes And Treatment

Typhoid fever is a bacterial infection affecting different body organs. Typhoid comes from Greek word typos that means cloud or smoke. It can spread throughout the body. It is also known as enteric fever. There are two types of enteric fever, typhoid and paratyphoid fever. It is most common in less developed countries. Countries having poor sanitation and unhygienic water are highly susceptible to typhoid fever. It can be a fatal disease. Typhoid fever roughly affects 21.6 million people each year. It kills 216000-600000 people each year. The occurrence of typhoid fever in Asia is 65% and in Africa it is 35%.

Symptoms

The clinical presentation of typhoid fever or enteric fever mainly consists of,

• Fever as high as 104ᴼF
• Poor appetite
• Headaches
• Generalized aches and pains
• Lethargy
• Diarrhea
• Chest congestion
• Abdominal pain and tenderness
• Occasionally a rash of flat rose colored spots (red spots)
• Typhoid meningitis

Stages of typhoid fever

There are four stages of typhoid fever. The duration of each stage is about a week.

Stage One

• A slowly rising temperature
• Relative bradycardia (Heart beat is slower than normal)
• Malaise (discomfort or uneasiness)
• Headache & cough
• In some cases, epistaxis(mile hemorrhage from nostril) can occur

Stage Two

• Continuing high fever
• Extremely distended abdomen
• Bradycardia continues
• Weight loss
• Delirium (sudden change in the brain that causes mental confusion)

Stage Three

In this stage, different complications occur such as,

• Intestinal hemorrhage due to bleeding
• Encephalitis (Inflammation of brain)
• Intestinal perforation
• Fever is still very high
• Excessive dehydration
• Delirium continues
• Motionlessness

Stage Four

•  A stage is reached in which fever is extremely high called defervescence

Incubation Period

Usually 10 to 14 day. It can be as long as 21 days or as short as 3 days. This duration depends upon the dose of drug ingested.

Causes

The Gram-negative bacterium that causes typhoid fever is Salmonella Typhi, also known as Salmonella enterica serotype Typhi. Salmonella paratyphi is another bacterium that causes paratyphoid fever. This disease is transmitted by fecal oral route or urine oral route. Typhoid fever is also transmitted directly with hands contaminated with feces or urine of carriers. It is also transmitted from one person to another person indirectly by the ingestion of contaminated milk and food. Flies are also carriers in typhoid fever. Ice, ice creams and dairy products contaminated with bacteria carries a high risk of infection. After ingestion, bacteria enter the bloodstream. Then it travels to the small intestine. White blood cells (WBCs) carry this disease to the liver, spleen and bone marrow. In these organs, a bacterium reproduces and again enters the bloodstream. This bacterium can also invade the gallbladder, biliary system and lymphatic tissue of the bowel.

Treatment

Effective treatment plan for typhoid fever contains antibiotics such as ceftriaxone and ciprofloxacin. Until the late 1980s, the standard treatment for typhoid fever was 14–21 days of chloramphenicol, TMP-SMX, or ampicillin. In case of fully sensitive patients, optimal therapy includes fluoroquinolones and ciprofloxacin/levofloxacin in the dose of 15mg/kg for 5-7 days. In alternative effective treatment, chloramphenicol, amoxicillin and Trimethoprim/sulfamethoxazole (SMX-TMP) are given for 14-21 days. In case of multidrug resistant patients, optimal therapy includes fluoroquinolones or cefixime. And the alternative effective drugs include azithromycin and cefixime. In case of quinolone resistance, optimal therapy includes azithromycin or ceftriaxone. In alternative treatment, cefixime is recommended.

Supportive therapies

Steroids can also be used in adults and children with severe enteric fever characterized by delirium, coma, or shock. For example, dexamethasone in the dose of 1 mg/kg every 6 hours for 24 to 48 hours is very effective. We should also have some appetizers. Oral nutrition such as fluids that can be easily digested is preferred. Electrolytes should be given and monitored. Person suffering from typhoid fever should take a complete bed rest until he recovers.

Vaccination

Immunization or vaccination is also available for typhoid fever. Vaccination is effective for three years and then it needs a booster dose. Vaccination is not effective for paratyphoid fever. Vaccine that are available includes,

• Injectable typhoid vaccine (TYPHIVAX)
• TAB vaccine
• The oral live vaccine (TYPHORAL)