Typhoid fever, also known as enteric fever, is one of the illnesses caused by the gram-negative Salmonella species. There are many different types of Salmonella species, but Salmonella Typhi is the most common cause of typhoid fever. It typically causes abdominal pain and high-grade fever and is common in areas with poor sanitary conditions.
You will often see paratyphoid fever mentioned in conjunction with typhoid fever due to the similar symptoms presented by both the diseases, but paratyphoid has milder symptoms.
Also, the S. Paratyphi bacteria, which cause salmonellosis, a type of food poisoning, are not related to S. Typhi.
Causes and spread of typhoid fever
Salmonella Typhi, a type of bacteria, causes typhoid fever, lives in infected person’s gut (the small intestine), and can infect food and water though the faecal–oral route. Typhoid fever is spread by drinking water or eating food contaminated with an infected person’s stool or urine.
Salmonella Typhi bacteria can be found in the poop of an infected person. They may contaminate any food products they touch if they do not properly wash their hands afterward. Anyone else who consumes this food may become infected as well.
Less frequently, Salmonella Typhi can also be found in the urine of an infected person. Again, proper hand washing after urinating is critical because the infection can be passed on to someone who consumes the contaminated food if the infected person touches it without first cleaning their hands.
In areas where sanitation is poor, contaminated human excrement can infect the water supply.
Typhoid fever can be contracted by drinking contaminated water or consuming food that has been washed in contaminated water.
Other ways you can get typhoid fever are as follows:
• Using a public restroom contaminated with Salmonella Typhi bacteria and touching your mouth without thoroughly washing your hands
• Having anal or oral sex with a S. Typhi bacteria infected or carrier
• Consuming infected milk products or eating fruits and vegetables fertilised by human excreta infected by Salmonella Typhi bacteria
• Eating sea food from the contaminated water by infected person’s urine or excreta.
Spread through the bloodstream
Bacteraemia occurs when S. Typhi bacteria circulate in the bloodstream from the digestive tract and spread the disease to distant organs, including the following:
• Lungs (resulting in pneumonia)
• Kidneys (resulting glomerulonephritis)
• Joints (resulting in infectious arthritis)
• Bones (causing osteomyelitis)
• Heart (causing endocarditis)
• Gallbladder, spleen, and liver
• Tissues that surround the brain (resulting in meningitis)
These infections mainly occur when people receive delayed treatment or go untreated.
Signs and symptoms of typhoid fever
The of typhoid fever usually appear 1 to 2 weeks after an individual has been infected with the S. Typhi bacteria.
With treatment, typhoid fever symptoms should improve significantly within 3 to 5 days.
If typhoid fever is not treated, it usually worsens over a few weeks, with a considerable risk of further development of fatal complications. Moreover, without treatment, there is a risk of relapse of the typhoid symptoms, and it can take weeks or even months to fully recover.
Some of the main symptoms of typhoid fever include:
• Appetite loss
• Pain in the stomach
• Rash called ‘rose spots’, which usually appears on your stomach or chest
• Muscle aches
• Vomiting and nausea
• Constipation or diarrhoea
Clinical presentation of typhoid fever symptoms
Both Salmonella Typhi and Salmonella Paratyphi are indistinguishable clinically. Typically, the disease symptoms appear 7–14 days after the organism is ingested. It usually starts with a fever, rising in a typical ‘stepladder’ pattern.
Typhoid fever symptoms can appear in stages. Early antibiotic treatment can help you avoid it from progressing to more advanced stages.
During the initial week of the disease, a wide range of gastro-intestinal signs and symptoms develop. These symptoms include tenderness and diffuse pain in the abdomen as well as sharp pain in the right upper side of the abdomen in some cases. There can be inflammation of Peyer’s patches (watchmen of the small intestine; they identify harmful pathogens), which can narrow the lumen and lead to constipation that may last for the entire duration of the illness. If left untreated, the person may experience a dull headache in the front region of the head, dry cough, delirium, and severe malaise with marked stupor (a mental state where a person becomes less responsive).
After 7 to 10 days, fever begins to level off at 103 to 104 °F (39 to 40°C). Some people may develop a few (usually fewer than 5) ‘rose spots’ (maculo-papules or raised areas in the rash) on the chest and abdomen region. These usually go away after 2–5 days.
The aforementioned signs and symptoms progress in the second week. Soft splenomegaly (mild spleen enlargement) is common, and the abdomen becomes distended. Relative bradycardia (slower heartbeat) can occur.
Along with fever, the infected person becomes anorexic (loses appetite) and loses a lot of weight by the third week. The patient’s conjunctivae are infected, and they become tachypneic (tachypnea is a condition causing rapid pulse rate). Severe stomach distension persists. Some patients develop bad-smelling, yellow-green, watery diarrhoea also known as pea soup diarrhoea. The individual may develop a typhoid state that involves symptoms including confusion, apathy, or even psychosis. Peritonitis and bowel perforation can occur as a result of necrotic Peyer’s patches. This complication is frequently unnoticed and can be covered up by corticosteroids. At this point, the patient could die from toxaemia (toxins released by bacteria into the bloodstream), myocarditis (inflammation of the heart muscles), or intestinal haemorrhage.
If the infected person makes it to week four, the fever, abdominal distension, and mental state gradually improve over the next few days. In untreated survivors, neurologic and intestinal complications can still occur. The extreme weakness and weight loss last for months. Additionally, some survivors are asymptomatic S. Typhi carriers.
Atypical (unusual) manifestations of typhoid fever
Atypical typhoid fever manifestations include the following:
• Isolated headache, severe intensity resembling meningitis
• Arthralgias (isolated)
• Acute lobar pneumonia
• Jaundice (severe)
• Urinary symptoms
Some patients, particularly those from Africa and India, present with mainly neurologic symptoms, including delirium or, in rare instances, Guillain–Barré syndrome or parkinsonian symptoms. Pancreatitis, osteomyelitis, orchitis, abscesses, and meningitis anywhere on the body are also uncommon complications.
Diagnosis of typhoid
Typhoid is diagnosed through the examination and culture of stool, blood, or other body fluids or tissue samples.
To verify the diagnosis of enteric fever, doctors collect blood, urine, stool, and other bodily fluids or tissue samples and send them for culture to the laboratory. These samples are tested and examined to see if Salmonella Typhi bacteria are present.
Treatment for typhoid
The most effective treatment for typhoid symptoms is antibiotic therapy.
Other therapies include the following:
• Adequate hydration: Patients with typhoid fever should consume ample quantities of fluid, or fluids must be administered intravenously if the person is dehydrated due to prolonged fever.
• Surgery: Surgery is done if typhoid causes complications such as intestinal perforation. If the intestines are torn, the patient will need surgery to address the problem.
• Depending on the seriousness of the infection, supportive therapies such as electrolyte replacement may be used.
Prognosis (outcome) of typhoid
Treatment usually improves symptoms in 2 to 4 weeks. With early treatment, the overall result is likely to be good, but if complications arise, the outcome becomes poor. Moreover, if the infection is not completely cured, symptoms may reappear.
Prevention of typhoid fever
Tourists planning to visit the Typhoid endemic regions should get themselves vaccinated, at least two weeks prior to the visit so that the body gets enough time to make antibodies to fight typhoid. Although vaccination is not 100% effective, it provides adequate protection against typhoid.
In general, the following foods are safe to consume:
• Foods served hot right after they have been cooked
• Sealed bottles or cans of beverages
• Hot coffee or tea
• Self-peeled fruits
Avoid the following while you are out:
• Avoid eating raw fruits and vegetables
• Avoid eating foods kept at room temperature for a longer time
• Brushing your teeth should be done with bottled water that has been sealed
• People should not consume ice and water outside because it is unsafe unless the water is chlorinated or boiled before use
• Avoid eating fruits that do not need peeling
What are the most common symptoms of typhoid?
High grade pyrexia (high fever), stomach pain, headache, and diarrhoea or constipation are common symptoms of typhoid fever.
Are the symptoms of malaria and typhoid fever the same?
No, malaria and typhoid fever are two different illnesses caused by different organisms. While malaria is a parasitic infection, typhoid is a bacterial infection. Furthermore, both typhoid and malaria share a number of symptoms and signs that vary in severity.
Is a rash a typhoid symptom?
Yes, it is possible to have a rash as a typhoid symptom; however, a typhoid rash is a typical salmon-coloured rose spot maculopapular rash with a small number, mainly on the chest and abdomen region.
Are the symptoms of typhoid different in adults and children?
The typhoid symptoms in children are similar to those in adults, but children are seen to experience milder symptoms than adults.
Does having a continuous high fever indicate one of the symptoms of typhoid?
Having a continuous fever is one of the signs of typhoid, but it is recommended that you contact your doctor for a correct diagnosis.