Typhoid Fever: Causes, Symptoms, Diagnosis and Treatment

As per the World Health Organisation (WHO), around 9 million people get diagnosed with typhoid fever globally every year. Typhoid fever, also referred to as enteric fever, is a bacterial infection that spreads through contaminated water and food. Let us understand the causes, symptoms of typhoid, treatment, vaccination options, and much more.

What is Typhoid Fever?

Typhoid fever, caused by Salmonella typhi mainly infects the small intestine and is most common in rural regions of developing countries like Southeast Asia. Climate change and urbanisation are the common factors that contribute to the spread of typhoid globally. 

Contaminated food and water are major reasons behind the spread of the disease. This happens when someone suffering from typhoid fever touches food or water with contaminated hands or when the wastewater comes in contact with the drinking water or food. 

With proper treatment, one can avoid severe symptoms and make a complete recovery. However, untreated typhoid can result in some life-threatening complications.    

Symptoms of Typhoid

People who have contracted typhoid are likely to first have a fever, where the temperature keeps increasing gradually and reaches 104 degrees Fahrenheit. With time, the infected individuals start experiencing other symptoms as well. They are as follows: 

• Headaches and chills
• Stomach pain
• Loss of appetite
• Rashes
• Nausea and vomiting
• Constipation or diarrhoea
• Fatigue and weakness
• Muscles aches

In severe cases, an infected person may experience perforations in the intestine or intestinal bleeding, which can lead to sepsis (a serious bloodstream infection). Other possible complications of typhoid include: 

• Infection in the kidney or bladder 
• Pneumonia and bronchitis 
• Psychiatric issues like delirium and paranoid psychosis
• Meningitis
• Mycotic aneurysm
• Myocarditis
• Endocarditis
• Kidney failure

Typhoid Causes

Typhoid is caused by the bacteria Salmonella typhi. It is transmitted from the contaminated food and water. 

• In some cases, the infection can pass to someone who has come in direct contact with the infected person. 
• The disease-causing bacteria come out from the body of the infected individual through urine and stool. In case the infected individual has not washed their hands after using the washroom, the bacteria can easily transmit from the hands to the object that they have touched. 
• You can also contract the infection from an individual who has recovered from typhoid. These people carry the disease-causing bacteria even after recovering and are referred to as chronic carriers. Though they do not experience any symptoms but can still pass the bacteria through their urine and stools.  

Typhoid Diagnosis

You can get your typhoid fever diagnosed by undergoing several tests that use samples of blood and stool. Tests recommended to diagnose typhoid fever include:

• Widal test: Measure antibodies formed against the typhoid bacteria
• Complete Blood Count (CBC): Measures the count of different blood cells
• Typhidot IgG & IgM: Comes positive in the case of typhoid infection in the blood

In severe cases, healthcare providers can also take a sample of your bone marrow to trace infection. Doctors often recommend X-rays to examine any changes in the lungs. 

Typhoid Treatment

Generally, doctors suggest antibiotics for treating typhoid. the most commonly prescribed antibiotics include: 

• Carbapenems
• Azithromycin
• Ceftriaxone
• Cefixime
• Ciprofloxacin
• Ofloxacin
• Levofloxacin

In case of severe complications, doctors may recommend steroids like dexamethasone. Besides having the medicines, you must ensure to keep yourself hydrated. If you are severely ill and the symptoms worsen with time, consult your doctor immediately. 

Antibiotic Resistance in Typhoid 

Sometimes the bacteria Salmonella typhi, becomes resistant towards antibiotics, making the treatment difficult. This usually happens when an antibiotic has already been consumed by the patient a lot of times before, hence it stops working when used against the typhoid infection.

XDR typhoid is one such strain of typhoid infection that is extremely drug resistant. Hence, people are advised to get vaccinated against the disease to prevent such situations.  

Typhoid Vaccine

Doctors recommend vaccines only if you have contacted a carrier, you are yourself a carrier, you work in a laboratory or you visit areas where typhoid is common. The typhoid vaccine can be administered orally or through injections. 

• Oral vaccines (capsule): This vaccine consists of four pills that are given to the carriers or people travelling to risky areas every other day. The last dose is given before 1 week of the trip. This vaccine contains live and attenuated (weakened) bacteria, that trigger the production of antibodies against the disease. It can be given to adults and children who are above 6 years. 
• Injectable vaccines (shot): It is an inactivated vaccine that can be given to children below 2 years as well as to adults. This must be taken 2 weeks before the trip. For those who have already taken the shot, taking a booster shot is also important before they start travelling. 

However, the vaccines do not remain effective for a long time. This is the reason why you should be aware of the precautionary measures and know the guidelines while travelling to or staying in high-risk areas. 

Typhoid Prevention

The best way to save yourself from contracting typhoid fever is to get vaccinated, especially if you are residing in an area where the spread of typhoid is common. 

Besides, you must be careful regarding what you eat and drink, and be mindful of maintaining hygiene. Here are the tips following which one can avoid contracting this serious infection:

• Avoid drinking from tap water. Further, avoid consuming roadside popsicles, or ice cubes.
• Refrain from eating raw produce unless it is properly peeled and washed.
• Avoid eating raw meat or fish. 
• Avoid having food from street vendors. 
• Do not make food for other family members if you are ill.
• Avoid drinking untreated water. Even do not eat foods that are prepared using untreated water. 
• Maintain hygiene and wash your hands properly before eating food and after using the bathroom. You can also carry an alcohol-based sanitiser.

Takeaway

Typhoid is a serious infection that can be life-threatening in the absence of proper treatment. If you experience the aforementioned symptoms of typhoid, consult a specialist for further investigation. 

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 Medically reviewed by Dr Sonia Bhatt.