Typhoid fever is a disease caused by the bacteria known as Salmonella Typhi (S. Typhi). The bacteria infects your small intestines and causes high fever, stomach pain and other symptoms. It can also be called enteric fever.
Food and water with the bacteria in it cause the bacteria infection. Close contact with a person who is carrying the salmonella bacteria also can cause the disease.
It’s estimated that 11 million to 21 million people around the world get typhoid each year.
Most people who have the disease feel better about a week after they start treatment to kill the bacteria with antibiotics. But without treatment, there is a possibility chance of death from complications.
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Symptoms of typhoid fever
This bacteria infection gets its name from a high fever that can last for weeks if left untreated. It often gets progressively worse over a few days.
Other symptoms of typhoid fever include:
- Chills.
- Headache.
- Loss of appetite.
- Stomach (abdominal) pain.
- “Rose spots” rash, or faint pink spots, usually on your chest or stomach.
- Cough.
- Muscle aches.
- Diarrhea or constipation.
- Nausea, vomiting.
With some people, symptoms may return up to a few weeks even after the disease has gone away
You can also read about symptoms and causes of cholera.
Causes of typhoid fever
The bacteria strain called Salmonella enterica (S. Typhi) causes the disease. Other strains of salmonella bacteria cause a similar disease called paratyphoid fever.
People pick up this bacteria most often in places where outbreaks are common. The bacteria passes out of the body in the stool and urine of people who are carrying it. Without careful hand-washing after going to the bathroom, it can move from the hands to objects or other people.
The bacteria can also spread from a person who carries it. It can spread on food that isn’t cooked, such as raw fruits without a peel. In places where water isn’t treated to kill germs, you can pick up the bacteria from that source. This includes drinking water, using ice made from untreated water, or by drinking unpasteurized milk or juice.
Salmonella Typhi carriers
Sometimes after treatment with antibiotics, a small number of people who recover from the disease still have the bacteria living in their bodies. These people are known as chronic carriers. They no longer have symptoms of the disease. But they still shed the bacteria in their stools and spread it.
Stages of typhoid fever
You can develop symptoms of typhoid fever gradually in four stages. Early treatment with antibiotics can keep you from progressing to severe stages. The stages of typhoid infection include:
- Stage 1. You can start getting typhoid symptoms anywhere from five to 14 days after coming in contact with S. Typhi. The first symptom is a fever that gets higher over a few days, called “stepwise” since it goes up in steps. The bacteria is moving into your blood in this stage.
- Stage 2. Around the second week of fever, the bacteria is multiplying in your Peyer’s patches (part of your immune system that identifies harmful invaders). You’ll start experiencing abdominal pain and other stomach symptoms, like diarrhea or constipation. You might get “rose spots,” small pink dots on your skin that look like a rash.
- Stage 3. If not treated with antibiotics, the bacteria can cause severe damage, usually around the third week after your symptoms start. Some people get serious complications, like internal bleeding and encephalitis (inflammation in your brain).
- Stage 4. Stage four is when most people begin to recover. Your high fever begins to come down. S. Typhi can live in your gallbladder without causing symptoms, which means you may still be contagious even after you feel better.
You can also read about stages and risk factors of pneumonia.
Risk factors of typhoid fever
This bacteria infection is a serious worldwide threat and affects millions of people each year. Places with the highest number of cases or with regular outbreaks are in “Africa and South Asia” But cases are recorded worldwide, often due to travelers to and from these areas.
The following can make you be at risk of typhoid fever if you:
- Have close contact with someone who is infected or has recently been infected with the disease.
- Work or travel in areas where the salmonella bacteria infection is established, especially if you travel to visit family or friends. People visiting loved ones may have higher social pressure to drink or eat foods that present a higher risk.
- Also when you work as a clinical microbiologist handling the Salmonella enterica serotype typhi bacteria.
Complications of typhoid fever
If typhoid fever is left untreated, you’re at risk of severe complications, which can include:
- Intestinal perforation (a hole in your intestines).
- Internal bleeding.
- Swollen or burst gallbladder.
- Neurological (brain) symptoms, including confusion, delirium and seizures.
- Swelling around your brain (meningitis).
- Bronchitis, pneumonia or other respiratory issues.
- Heart inflammation.
- Miscarriage.
- Kidney failure.
- Bone inflammation (osteomyelitis).
Prevention of typhoid fever
The best way to prevent typhoid fever is to watch what you eat and drinks, overall practice good hygiene. The following are the tips to take:
Watching what you eat
- Avoid food from street vendors.
- Don’t eat raw produce unless you can peel it yourself after washing your hands.
- Don’t eat raw or rare meat or fish. Foods should be thoroughly cooked and still hot when served.
- Avoid salads and condiments made from fresh ingredients.
- Eat only pasteurized dairy products and hard-cooked eggs.
Be careful of what you drinking
- Avoid ice cubes, popsicles, or fountain drinks unless you’re certain they’re made from bottled or boiled water.
- Don’t drink from the tap or a well.
- Buy bottled drinks whenever possible (carbonated water is safer than noncarbonated water, be sure bottles are tightly sealed).
- It’s safe to drink pasteurized milk, hot tea, and hot coffee.
- Non-bottled water should be boiled for 1 minute before drinking.
Practicing good hygiene
- Don’t touch your face unless you’ve just washed your hands.
- Wash your hands often, especially after using the bathroom and before touching food (use lots of soap and water if available, if not, use hand sanitizer containing at least 60 percent alcohol).
- If you’re sick, avoid other people, wash your hands often, and don’t prepare or serve food.
- Avoid direct contact with people who are sick.
You can also read about complications and prevention of syncope (fainting).
Diagnosis of typhoid fever
You doctor will use your symptoms, your history of traveling and laboratory tests to diagnose the infection. Your doctor will give you a physical exam and listen to your heart and lungs.
Also very important to tell your provider if you’ve traveled recently or think you’ve been exposed to typhoid, otherwise they might not know to test for it. Your doctor will now use the information to decide what treatment is good for you.
Your provider will take samples of body fluids or tissue to test for signs of S. Typhi. They might take samples from:
- Pee (urine). You may be asked to pee into a cup given to you by your healthcare provider.
- Blood. Your provider will use a needle to take a small tube of blood from your arm.
- Poop (stool). Your healthcare provider will give you a sterile container and instructions on how to collect a sample.
- Bone marrow. Your provider will numb your skin and use a special needle to get a sample of the inside of your bones. It’s rare that you’d ever need this test for diagnosis.
- Your provider might numb your skin and take a sample with a small razor or scalpel.
- You provider may also take X-rays (pictures of the inside of your body) to look for changes in your lungs.
Treatment of typhoid fever
Antibiotic treatment is the best effective treatment for typhoid infection.
The medications you get to treat typhoid disease may depend on where you picked up the bacteria. Strains picked up in different places respond better or worse to certain antibiotic medications. These medicines may be used alone or together. Antibiotics that may be given for this disease are:
- Cephalosporins. This group of antibiotics keeps bacteria from building cell walls. One kind, ceftriaxone, is used if there is antibiotic resistance.
- Fluoroquinolones. These antibiotics, including ciprofloxacin (Cipro), may be a first choice. They stop bacteria from copying themselves. But some strains of bacteria can live through treatment. These bacteria are called antibiotic resistant.
- Carbapenems. These antibiotics also prevent bacteria from building cell walls. But they focus on a different stage of that process than the cephalosporins. Antibiotics in this category may be used with severe disease that doesn’t respond to other antibiotics.
- Macrolides. This group of antibiotics keeps bacteria from making proteins. One kind called azithromycin (Zithromax) can be used if there is antibiotic resistance.
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.
Other treatment options include:
- Fluids. Drinking fluids can helps prevent the dehydration caused by a long fever and diarrhea. If you’re very dehydrated, you may need to receive fluids through a vein.
- Medical procedure. If the intestines are damaged, you may need surgical procedure to repair them.
If you’re treated early with an antibiotic, you should start to feel better in a few days. It might take a week to 10 days to feel completely recovered.
The infection can lasts 7-10 days when treated soon after symptoms start. If untreated or if treatment starts later, it can last three weeks or longer. If you have complications or a relapse, it can take longer than that to fully recover.
Typhoid fever vaccine
There are two vaccines for typhoid infection. They don’t last forever, you will need to get additional doses to stay protected. They greatly reduce your risk but don’t guarantee you won’t get typhoid.
With most people in good overall health, the vaccine is not necessary. But your provider might recommend one if you are:
- in close contact with a carrier
- a carrier (someone who’s asymptomatic but can still spread the bacteria that causes typhoid)
- traveling to a country where it is common
- a laboratory worker who may come in contact with the bacteria
- Inactivated typhoid vaccine. This vaccine is a one-dose injection. It’s not for children younger than 2 years old, and it takes about 2 weeks to work. You can have a booster dose every 2 years.
- Live typhoid vaccine. This vaccine is not for children under age 6. It’s an oral vaccine given in 4 doses, 2 days apart. It takes at least a week after the last dose to work. You can have a booster every 5 years.
Getting the vaccines is the best way to protect yourself from typhoid infection. But you should also take steps to avoid eating or drinking things that could be contaminated with the bacteria. This is true both at home and when you are traveling.
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