Typhoid fever

 

Enteric fever, also known as typhoid fever, is a digestive tract infection characterized by fever, headache, and abdominal pain or discomfort. It is a serious health hazard in developing countries like India and South Africa.

 

 

The causative agent of typhoid fever is a bacterium called Salmonella typhi which is transmitted via contaminated water or food containing the bacteria (feco-oral or urine-oral route).

Risk factors include:

1. Travel to areas where typhoid fever is a common disease

2. Being in a profession where contamination with bacteria is likely. Like those working in laboratories.

3. Coming in close contact with a person suffering from typhoid

4. Drinking/eating contaminated water or food

 

 

Signs and symptoms develop gradually over the period of 10 to 14 days after exposure to the bacteria. Common signs and symptoms are:

1. Irregular fever that can go up to 104.9°F (40.5°C)

2. Headache

3. Pain in abdomen

4. Tiredness

5. Muscular pain

6. Loss of appetite

7. Nausea

8. Constipation or diarrhea

Physical findings in early stages include:

1. Abdominal tenderness

2. Enlarged spleen and liver

3. Enlarged lymph nodes

4. Rash also known as rose spots because of their appearance

 

 

Investigations include:

1. Typhoid test to detect IgM and IgG antibodies

2. Blood culture to test for S. typhi

3. Stool analysis

4. Urine analysis

5. Bone marrow culture is the most sensitive test, but it is rarely required except in patients who have already received antibiotics and not getting

6. Widal antigen test can be done, but there is a longer waiting phase of about 10 days till results can be seen, it is time consuming and is prone to give false positive results. 

 

 

Antibiotics are the main line of treatment for enteric fever. Due to increased resistance to ciprofloxacin the new drugs of choice are azithromycin and ceftriaxone. In some cases chloramphenicol, co-trimoxazole, and amoxicillin may also be effective.

 

 

If not treated and sometimes even after treatment, there can be serious complications due to typhoid like pneumonia, meningitis (inflammation of meninges of brain), infection in bones (osteomyelitis), intestinal perforation, and intestinal hemorrhage. If left untreated, it can lead to death.

A doctor needs to be consulted if a person starts developing the symptoms few days after returning from your tour, if he/she has fever that is very erratic along with other symptoms which do not subside with home treatments.

 

 

If treated promptly, the prognosis of enteric fever is very good. Even after recovering, clinically 5% to 10% of the patients continue to excrete S. typhi in stools for several months to more than a year and are called carriers. These patients require long-term antibiotic treatment.

 

 

1. Typhoid fever can be prevented by improving sanitation facilities and clean drinking water. Hands must be washed with soap and warm water after using restrooms, before eating or cooking food.

2. Maintaining optimum personal hygiene is the key to preventing this disease.

3. Travelers should not drink untreated water.

4. Roadside food items should be avoided.

5. Vaccines are available that gives partial protection.

 

 

1. Man is the only natural host for the S. typhi bacteria.

2. According to the most recent estimates published in 2014, approximately 21 million cases and 222,000 typhoid-related deaths occur annually worldwide.