Typhoid Fever

Typhoid fever is an infectious disease caused by the bacteria Salmonella Typhi (S. Typhi). It primarily targets your small intestine, leading to a high fever, stomach pain, and a variety of other symptoms. This disease also goes by the name enteric fever.

Not All Salmonella Are Created Equal

You might hear about paratyphoid fever and typhoid fever. Paratyphoid fever is similar to typhoid fever but with milder symptoms. It’s caused by a different bacteria, Salmonella Paratyphi (S. Paratyphi). It’s important to note that both S. Typhi and S. Paratyphi are distinct from the Salmonella bacteria responsible for salmonellosis, a common type of food poisoning.

Who Gets Typhoid Fever?

Typhoid fever is most prevalent in developing countries with limited access to modern sanitation, particularly in rural areas. South and Southeast Asia, Central and South America, Africa, and the Caribbean are the regions most affected. Travelers visiting Pakistan, India, or Bangladesh are at a higher risk of contracting the disease. Children are also more susceptible to typhoid fever than adults.

The Global Reach of Typhoid Fever

Worldwide, estimates suggest that between 11 and 21 million people fall sick with typhoid fever annually. Thankfully, the disease is rare in developed countries like the U.S., Canada, Japan, Western Europe, and Australia.

Long-Term Carriers

In some cases, individuals can remain contagious with typhoid fever even after recovering from the illness. These individuals become long-term carriers, potentially spreading the bacteria for a year or more without experiencing any symptoms themselves. Getting tested for S. Typhi after recovery is crucial to ensuring you’re not unknowingly transmitting the disease to others.

Typhoid vs. Typhus: Don’t Be Confused by the Names

Despite their similar-sounding names, typhoid fever and typhus are entirely different illnesses caused by distinct bacteria. While the symptoms can be quite similar, leading to historical confusion between the two, they are separate conditions

Symptoms of typhoid fever

The hallmark symptom of typhoid fever is a high fever that can last for weeks if left untreated. This fever typically worsens gradually over a few days. Here are other signs to watch out for:

• Headaches
• Chills
• Loss of appetite
• Stomach pain
• A faint pink rash on your chest or stomach, known as “rose spots,”
• Cough
• Muscle aches
• Nausea and vomiting
• Diarrhea or constipation

Causes of typhoid fever

S. Typhi bacteria live in the gut of infected individuals and can contaminate food and water sources.

How Typhoid Fever Spreads: Be Aware, Be Prepared

Typhoid fever spreads most commonly through contaminated food or water. This can happen in a few ways:

• Direct Contact: If someone infected with typhoid fever doesn’t wash their hands after using the bathroom and then touches your food or drink, the bacteria can spread.
• Contaminated Water: If sewage or wastewater gets into your drinking water, it can become contaminated with S. Typhi.
• Contaminated Food: Food washed or prepared with contaminated water can also harbor bacteria.

Stages of typhoid fever

Here’s a breakdown of what you might experience during the four stages of typhoid fever:

Stage 1: (5–14 days after exposure)

This is the early stage, where the bacteria (S. Typhi) is slowly making its way into your bloodstream. You might not even notice anything at first, but a slow-burning fever that gradually increases over a few days could be your first clue. Doctors call this “stepwise fever” because it rises in small steps, unlike a sudden spike.

Stage 2: (Around the second week)

By now, the bacteria has reached your Peyer’s patches, which are part of your body’s defense system located in your intestines. This can cause some uncomfortable stomach issues, including abdominal pain, constipation, or diarrhea. You might also develop a distinctive rash called “rose spots,” which are small, pink dots that appear on your skin.

Stage 3: (Third week onwards, if untreated)

If left untreated with antibiotics, things can take a turn for the worse around week three of typhoid fever. The bacteria can cause serious damage, leading to complications like internal bleeding and even inflammation in your brain (encephalitis). This stage can be very dangerous, so seeking medical attention early is crucial.

Stage 4: (Variable)

Finally, with proper treatment, most people start to recover during stage four. The high fever gradually subsides, and you begin to feel better. However, it’s important to remember that S. typhi can linger in your gallbladder without causing any symptoms. This means you might still be contagious to others even after you recover, so following your doctor’s instructions for preventing further spread is essential.

Diagnosis of typhoid fever

Your doctor will start by asking you about your symptoms, like fever, fatigue, and stomach woes. They’ll also want to know if you’ve traveled recently, as typhoid fever is more common in certain areas. This travel history is crucial for them to suspect typhoid and order the right tests. They’ll also give you a physical exam, listening to your heart and lungs for any abnormalities.

To confirm the presence of the bacteria, Salmonella Typhi, doctors rely on lab tests from various samples.

• A blood test: This test is a quick and common method. A small blood sample is drawn from your arm and analyzed for bacteria.
• Stool Sample: You’ll collect a stool sample in a special container, allowing doctors to check for the bacteria in your feces.
• Urine Test: Similar to a stool sample, a urine test can also detect the bacteria in some cases.
• Bone Marrow Aspiration (Rare): In rare instances, doctors might need a sample from your bone marrow, the soft, inner core of some bones, to definitively diagnose the infection. This procedure involves numbing the skin and using a special needle to collect a small amount of bone marrow for testing.

Additional Tools (Less Common):

• X-rays: While not a direct test for typhoid fever, X-rays of your chest can sometimes reveal changes in your lungs that might support the diagnosis, especially if you have a cough.

Treatment for typhoid fever

Typhoid is treated with antibiotics. Some newer types of bacteria are able to survive antibiotic treatments, so you’ll be treated with different antibiotics depending on what type of typhoid you have and where you got sick. Paratyphoid fever is also treated with antibiotics.

If you’re severely ill or have complications, you might need additional treatments. You’ll probably need to be admitted to the hospital for these treatments.

What medications are used to treat Typhoid fever?

Your healthcare provider will treat typhoid fever with antibiotics, which may include:

• Ciprofloxacin, levofloxacin, or ofloxacin.
• Ceftriaxone, cefotaxime, or cefixime.
• Azithromycin.
• Carbapenems.

If your case is severe, you may be treated with steroids, like dexamethasone.

Antibiotic resistance in typhoid

Bacteria like S. Typhi can sometimes develop resistance to medications. This means that antibiotics don’t work to destroy them anymore (antibiotic resistance).

Many cases of typhoid can’t be destroyed by antibiotics we once used, but some drugs still work on them. Some are extremely drug resistant (XDR typhoid) and only a few antibiotics still work on them. This is one of the reasons that getting vaccinated to prevent typhoid is so important.

Health officials are concerned that we may no longer be able to treat typhoid if available medicines stop working. You’ll be treated with an antibiotic that works on the kind of typhoid you have based on the results of strain testing.

How do I take care of myself with typhoid fever?

To take care of yourself, make sure you finish all of your medicines as prescribed by your healthcare provider. Ask your provider if it’s safe to take non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil® or Motrin®), naproxen sodium (Aleve®) or acetaminophen (Tylenol®) for pain or fever.

Recovery After Treatment for Typhoid Fever

If you receive prompt treatment with antibiotics, you should begin to notice an improvement in your symptoms within a few days. However, it may take approximately a week to 10 days to fully recover and feel back to normal. It’s essential to complete the full course of antibiotics as prescribed by your healthcare provider, even if you start feeling better sooner, to ensure the infection is completely eradicated.

Signs of Recovery From Typhoid

• Absence of fever
• Improved appetite
• Reduced diarrhea
• Relief from body pain
• Increased energy levels
• Clear chest without congestion

Those who receive prompt antibiotic treatment typically start feeling better within a week, while delayed treatment may prolong recovery and increase the risk of complications. Approximately 5% of recovered individuals may become carriers of the bacteria, necessitating testing to confirm clearance before resuming normal activities.

Prevention of typhoid fever

Reducing your risk of typhoid fever involves a combination of vaccination, practicing good hygiene, and safe food handling practices.

Vaccines for Preventing Typhoid Fever:

There are two vaccines available for typhoid fever, both of which provide significant but not absolute protection against the disease. These vaccines require additional doses to maintain immunity over time:

1. Oral Vaccine: This vaccine consists of four pills taken every other day. It is recommended for individuals aged 6 and older. A booster is required every 5 years.
2. Injectable Vaccine (Shot): The injectable vaccine is administered as a single shot. It’s recommended to receive the vaccine at least two weeks before traveling to an area where typhoid is prevalent to allow sufficient time for the body to develop immunity. Booster shots are required every two years to maintain protection. Children over 2 years old can receive the typhoid shot.

Safe Food Practices for Preventing Typhoid Fever:

In addition to vaccination, practicing safe food handling and hygiene measures can help prevent typhoid fever:

• Refrain from preparing food for others if you’re feeling unwell.
• Wash your hands thoroughly with soap and water before and after handling food, eating, and using the bathroom.
• Clean and sanitize surfaces and utensils used for food preparation before and after each use.
• Opt for well-cooked or packaged foods when uncertain about the safety of food items.
• Avoid consuming untreated water or food prepared with untreated water. When in doubt, opt for bottled water for drinking and cooking purposes.

Outlook / Prognosis:

What to Expect with Typhoid Fever: The outlook for typhoid fever largely depends on how promptly you receive treatment. With timely antibiotic therapy, you may start feeling better within a few days of initiating treatment. However, it’s crucial to complete the full course of antibiotics as directed by your healthcare provider, even if you begin to feel better. Despite feeling improved, you may remain contagious for an extended period after symptom resolution.

Typhoid Relapse: In some cases, individuals may experience a relapse of typhoid fever, characterized by the recurrence of symptoms after apparent recovery. While relapses typically occur about a week after completing antibiotics, they can occasionally manifest weeks or even months later. If symptoms reappear, it’s essential to contact your healthcare provider promptly, as you may require another course of antibiotics.

Complications of Typhoid:

Untreated typhoid fever poses significant risks of severe complications, including:

• Internal Bleeding: This can be life-threatening and requires immediate medical attention.
• Intestinal Perforation: A hole in your intestines can cause severe abdominal pain and infection.
• Gallbladder Issues: Typhoid can inflame or rupture your gallbladder.
• Neurological Problems: Confusion, delirium, and seizures are possible complications.
• Swollen Brain (Meningitis): This can be a life-threatening complication.
• Respiratory Problems: Bronchitis, pneumonia, and other breathing issues can occur.
• Kidney Failure: Your kidneys may struggle to function properly.
• Pregnancy Complications: Miscarriage is a potential risk.
• Bone Inflammation (osteomyelitis): Typhoid can affect your bones in rare cases
• Heart Inflammation: Typhoid can affect your heart in rare cases.

Self-Care After Recovery

After recuperating from typhoid fever, it’s crucial to undergo follow-up appointments with your healthcare provider. They will conduct tests to ensure you are no longer contagious and monitor for any signs of relapse. If a relapse occurs or if you remain contagious, additional antibiotic therapy may be necessary.

When to Seek Medical Attention

Seek immediate medical attention if you experience:

• High fever.
• Bloody or tarry stool.
• Severe abdominal pain.
• Coughing up or vomiting blood.
• Neurological symptoms like confusion or seizures.

Note:

• Prompt antibiotic treatment aids in faster recovery from typhoid fever.
• Complications of untreated typhoid fever can be severe, including sepsis and organ damage.
• Vaccination is an effective preventive measure, but hygiene and food safety practices should still be observed.
• Regular testing may be necessary for individuals who have recovered from typhoid fever to confirm bacterial clearance.

Common Questions about Typhoid

Duration of Typhoid Fever:

Typhoid fever typically lasts for seven to 10 days when treated promptly after symptom onset. However, untreated or delayed treatment may prolong the illness for three weeks or more. Complications or relapses can further extend the recovery period.

Fatality Rate of Typhoid Fever:

While typhoid fever can be fatal if left untreated, modern medical interventions have significantly improved survival rates. Approximately 1% to 2% of typhoid cases result in fatalities. Timely diagnosis and appropriate treatment greatly reduce the risk of severe outcomes.

Returning to Work or School:

Returning to work or school after typhoid fever may necessitate clearance from your healthcare provider, especially if your occupation involves handling food or caring for vulnerable individuals. Even after symptom resolution, you could still carry the bacteria and potentially transmit it to others.

Contagiousness After Recovery:

Remarkably, individuals can remain contagious with typhoid fever even after symptom resolution, a phenomenon known as long-term carrier status. About 5% of individuals who have recovered from typhoid remain contagious for a year or longer. Regular testing post-recovery is essential to prevent further transmission of the infection.

How Did Countries Eliminate Typhoid Fever?

Many countries have successfully reduced the prevalence of typhoid fever through advancements in sanitation practices. Access to clean water for drinking and cooking, along with improved waste management systems, has significantly decreased the incidence of the disease in regions such as the U.S., Canada, Australia, and Western Europe. These measures have played a pivotal role in preventing outbreaks and protecting public health.

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