What is Typhoid fever? Typhoid fever is caused by Salmonella typhi bacteria and it can also be caused by Salmonella paratyphi which is a related bacterium but causes a milder illness. Typhoid fever is less in industrialized countries compared to developing countries due unhygienic condition of living. There are about 21 million people worldwide who get typhoid fever every year and from this around 20000 people die due to this disease. Typhoid fever is contagious and is spread through food and water that has been infected by the Salmonella typhi bacteria. It can also be spread with close contact to a person who is already infected with this disease. The symptoms caused with typhoid fever are very high temperature, pain in the abdomen, constipation or diarrhea. Most of the patients who have typhoid fever start to feel better within a couple of days post taking the antibiotic treatment but for few the disease may turn fatal and can eventually lead to death due to the complications. Today there are vaccines available for typhoid fever but it does not guarantee 100% protection from the disease. These vaccines are often reserved for those individuals who are exposed to the disease or are travelling to locations where this disease is common. Causes of typhoid fever: A person can get infected with typhoid fever if they consume any contaminated food or water or come in contact with anyone who is suffering from this disease. Those who have acute illness can contaminate the water in the surrounding area through their stools. The bacteria can be present in the water or dried sewage for weeks. And when food is prepared with this contaminated water or by an infected person who has not washed his/her hands after using the toilet the food also gets infected. A small percentage of people even after treatment with antibiotics continue to have the bacteria in their intestinal tracts or gallbladders and this may remain for years. These people are called chronic carriers and pass the bacteria in their stools and can pass the infection to other people even though they have no symptoms of the disease. Risk factors of typhoid fever Typhoid fever is a serious threat mainly in the developing countries due to poor sanitation and unhygienic living conditions. Few places where typhoid
fever is widespread are Southeast Asia, India, South America, Africa and many more countries. Children are more at risk of developing this disease compared to adults; however the symptoms among children are milder. A person is more at risk of developing this disease in the following scenarios;
Work or travel to locations where typhoid fever is widespread Work as a microbiologist who handles Salmonella typhi bacteria Contact with a person infected with typhoid fever Drink water or eat food that is contaminated with Salmonella typhi bacteria
Diagnosis of typhoid fever: Once the person has consumed any contaminated food or water, the bacteria attacks the small intestine and enters the bloodstream temporarily. The bacteria are then transported through the white blood cells to the liver, spleen and bone marrow where they multiply and again enter the bloodstream. Those who are infected start getting fever at this stage. When the bacteria multiply into larger numbers they attack the gallbladder, biliary system and lymphatic tissue of the bowel. Once the bacteria passes into the intestinal tract it can be diagnosed in the stool samples and if it is not detected in the urine test a blood test can also be done. Symptoms of typhoid fever: The symptoms of the disease start showing up gradually and it normally takes one to three weeks post exposure to the bacteria. The disease lasts for three to four weeks. The symptoms of the disease can be divided into early and later stages. Early stage symptoms:
Fever which increases gradually to about 104 F Loss of appetite Headache Weakness and lethargy Muscle pain Weight loss Sweating Abdomen pain or swollen abdomen Dry cough
Diarrhea or constipation Rashes
Later stage symptoms: If the infected person does not take any medication, he/ she may have the below mentioned symptoms.
Become restless and confused Lie down without moving and very exhausted
It can also cause serious complications which can even lead to death. Normally people who experience the symptoms of the early stage and start their treatment start showing improvement in the third or fourth week. In few people the symptoms may reoccur after improvement for one or two weeks. When to meet a doctor for consultation: One must meet a doctor if he/she is suffering from any of the above mentioned symptoms or suspects having typhoid fever. If a person is travelling to any locations that have cases of typhoid fever then he/she must carry a list of recommended doctors they can meet during any emergency. And if any symptoms start showing up post return then it is advisable to consult a doctor who mainly specializes on international travel medication and treatment of infectious diseases. A specialist will be in a better position to diagnose the illness by checking the patient, making note of the symptoms than any other doctor who may not be very familiar with these diseases. Treatment of typhoid fever: The treatment of typhoid fever is a course of antibiotics that kills the Salmonella bacteria present in the body. Earlier, before the use of antibiotics to treat typhoid fever the mortality rate was very high. Nowadays, the death caused due to typhoid fever has reduced considerably due to more awareness and prompt treatment with appropriate antibiotics. There are many antibiotics available in the market for treating this disease. Chloramphenicol was the medicine that was prescribed for many years. But with some rare side effects that affected few people, other antibiotics were introduced. The choice of antibiotics depends upon the location since certain
antibiotics are restricted in few areas. Also in people in whom the infection reoccurs, antibiotics are given again for complete cure. For people who are suffering from chronic infection are treated with prolonged antibiotics. In some such cases removing the gallbladder or a part of the chronic infection can be an option for treating the patients. And for people who are travelling to countries where there is a risk of developing typhoid disease, can take vaccines as a preventive measure.