Typhoid or enteric fever is mainly caused by the Salmonella enterica serovar Typhi bacteria and also, to a lesser extent, by Salmonella Paratyphi A. Humans are the only reservoir for these organisms. The primary sources of infection are the stool and urine of infected persons, with the essential carriers being contaminated water, food, and flies. The causative agent for this gastrointestinal infection is either waterborne or foodborne. The onset and severity of the disease mainly depend on the organism’s virulence and the infective dose.
Economically developing nations face the disease as a significant public health problem, particularly low-income countries of Asia and sub-Saharan Africa, where most of the population strives for safe water and have access to limited sanitation and hygiene infrastructure. A large-scale community study conducted in India in an urban slum setting has described the incidence of the disease as high as 2/1000 population/year under five years of age and 5.1/1000 population/year under ten years of age. A similar study from north India has reported that most cases occurred in children aged 5-12 years, wherein 24.8 per cent of cases were in children up to 6 years of age.
What is Typhoid?
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs. Without prompt treatment, it can cause severe complications and even be fatal. Typhoid is caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause salmonella food poisoning. It spreads between individuals through direct contact with the faeces of a person with an infection. No animals carry this disease, so transmission is always from human to human. S. typhi enters through the mouth and spends 1-3 weeks in the intestine. Then, it goes through the intestinal wall and into the bloodstream. From the bloodstream, it spreads into other tissues and organs. The host’s immune system can do little to fight back because S. typhi can live within the host’s cells, safe from the immune system.
Symptoms of Typhoid
Typhoid symptoms typically begin 1-3 weeks after contact with the bacteria. The two main symptoms of typhoid are fever and rash. Typhoid fever is exceptionally high, gradually increasing over several days and reaching up to 104ºF. The rash, which does not affect every infected person, consists of rose-coloured spots, particularly on the neck and abdomen.
Other symptoms that typhoid causes include:
- Diarrhoea
- Loss of Appetite
- Bloating
- Nausea
- Weakness
- Abdominal Pain
- Constipation
- Headache
Causes of Typhoid
Now, let’s look at what causes typhoid.
Typhoid is caused by the bacteria S. typhi. It spreads through food, drinks, and water contaminated with infected faecal matter. Washing fruit and vegetables with water that is contaminated can also spread it. Some people have typhoid without experiencing any symptoms. Others continue to harbour the bacteria after the symptoms have disappeared. Sometimes, the disease can reappear. Those who test positive for typhoid may not be allowed to work with children or older adults until medical tests are negative.
Who is Usually at Risk?
Typhoid fever is the most prevalent in South Asia and sub-Saharan Africa. People living, working, or travelling to places where typhoid is prevalent are at risk of contracting the bacteria. Typhoid outbreaks can happen in areas where sanitation and hygiene are insufficient. In the food industry, local outbreaks tend to occur where someone carrying the virus transmits it via food. People who work in restaurants or other food-related businesses may be more at risk. Most infected individuals feel better about a week after starting treatment with antibiotics. But if left untreated, typhoid fever complications can cause death in some cases.
Diagnosis of Typhoid
Diagnosing typhoid fever involves clinical assessment, laboratory tests, and the patient’s medical history. The common and most reliable diagnostic methods include blood cultures, wherein a sample of the patient’s blood, faeces, or urine is tested for the presence of the Salmonella typhi bacterium. The bacteria may not always be detected the first time so that you may need a series of tests. Such laboratory tests may include a complete blood count (CBC) for abnormalities. A Widal test helps detect specific antibodies against Salmonella typhi. These tests help confirm the bacteria’s presence and rule out the possibility of other illnesses with similar symptoms.
Treatment of Typhoid
The treatment of typhoid mainly involves consuming antibiotics to flush out the Salmonella typhi bacteria from the body. Common antibiotics prescribed include Ciprofloxacin, Ceftriaxone, and Azithromycin. The choice of antibiotics may depend on the severity of the illness, local antibiotic resistance patterns, and individual body suitability.
Always complete the entire course of antibiotics as prescribed by your doctor. Failure to do so can lead to the presence of hostile bacteria in the body, leading to antibiotic resistance.
Supportive care is also essential, including remaining hydrated through oral rehydration solutions. In severe cases, the doctor may recommend administering intravenous fluids. Maintaining proper nutrition supports the body’s healing process.
Recent medical advancements have successfully treated typhoid fever within three days, which used to take 10-14 days earlier. This is from administering third-generation Cephalosporins, such as Cefotaxime, Ceftriaxone, and Cefoperazone.
How can Typhoid be Prevented?
Countries with less access to clean water and washing facilities typically record higher typhoid cases. Preventing typhoid fever involves a combination of vaccination, good hygiene practices, and avoiding contaminated food and water.
Sometimes, a doctor may treat a person pre-emptively with antibiotics if they know the person will be in an area where the condition is endemic. Typically, they will prescribe Ceftriaxone or Cefixime along with Azithromycin.
Other preventive measures include the following —
- Vaccination: Before travelling to a high-risk area, a person should receive a vaccine against typhoid fever. The typhoid vaccine is available as an oral medication or a one-off injection.
- Capsule: This is a live, attenuated vaccine for adults and children over the age of 6 years. It consists of four tablets that a person should take every alternate day, the last of which is at least one week before travel.
- Shot: This is an inactivated vaccine needed two weeks before travel for adults and children over the age of 2 years. A previously vaccinated person should get a booster shot two weeks before travelling.
The typhoid vaccine is only 50-80% effective, so a person should still exercise caution when eating, drinking, and coming into contact with people. Anyone living with HIV should not take the live, oral dose. The vaccine may also have adverse effects.
After the oral vaccine, a person may experience:
- GI (Gastrointestinal) issues
- Nausea
- Headache
- Some people may faint after being vaccinated
However, severe side effects are rare with vaccines.
The following are some general rules to follow in locations where typhoid is prevalent, as these will help minimise the likelihood of typhoid infection:
- Drink bottled water, preferably carbonated.
- If there is no access to bottled water, boil available water for at least 1 minute before consumption.
- Be wary of eating anything that someone else has handled.
- Avoid eating at street food stands, and only eat food that is still hot.
- Do not have ice in drinks.
- Avoid raw fruit and vegetables; peel the fruit yourself, and do not eat the peel.
- Travellers to typhoid-affected areas should be particularly cautious. Besides vaccination, follow safe food and water practices, choose reputable food establishments, and be mindful of personal hygiene.
Complications Associated with Typhoid
A person with severe typhoid fever may experience severe vomiting, diarrhoea, and abdominal bloating. Such a condition requires immediate hospitalisation.
A person can also experience the following complications:
- Internal bleeding in the digestive system and ulcers
- Bowel perforation leads to peritonitis. This occurs in about 8-39% of people
- Sepsis
- Lung complications, such as abscess, empyema, or bronchopleural fistula
- Typhoid encephalopathy, which has a 55% mortality rate
- Meningitis
- Neurologic symptoms such as psychosis and muscle rigidity
- Myocarditis or Pericarditis
Conclusion
We recommend understanding and implementing preventive measures against typhoid fever as crucial to safeguarding individual and community health. Vaccination, proper hygiene practices, and access to clean water significantly reduce the risk of infection and the severity of the disease. One vital aspect often overlooked in health protection is the importance of health insurance. In the event of unexpected illnesses such as typhoid, health insurance provides a financial safety net, ensuring that individuals can access timely medical care.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.