Typhoid fever

Typhoid is a bacterial infection that affects the intestine. Generally, the signs and symptoms of typhoid fever develop gradually over a period of 10-14 days after exposure to the bacteria. The onset of the disease is usually gradual. The typical signs and symptoms of typhoid include:

• Irregular fever that can reach up to 104.9 ˚F (40.5 ˚C)
• Headache
• Abdominal pain
• Tiredness and weakness
• Muscle pain
• Loss of appetite (anorexia) and weight loss
• Constipation or diarrhea
• Confusion
• Low pulse rate
• Rose-colored spots on the neck, chest, or abdomen
• Swollen stomach
• Dry cough

As the infection progresses, a person may exhibit signs of extreme exhaustion and lie still with their eyes half-closed. This condition is referred to as the typhoid state. Typhoid can be fatal if left untreated, as it may lead to numerous complications.

Typhoid is highly prevalent in areas with inadequate access to clean water and sanitation. This is why developing and underdeveloped countries in Africa, South America, and Southeast Asia are known to be endemic for typhoid.

Typhoid fever is caused by the bacteria Salmonella typhi. The bacteria is transmitted through the oral-fecal route by the consumption of water or food contaminated by the feces of an acutely infected or a chronic, asymptomatic carrier. The various reasons for infection include:

• Eating food or drinking beverages touched by a carrier shedding Salmonella typhi in their feces, who has not washed their hands thoroughly after using the bathroom.
• Consuming water contaminated with infected fecal matter containing Salmonella typhi.
• Using contaminated water to rinse fruits and raw vegetables.
• Using ice made from contaminated water.
• Consuming fruits and vegetables grown in soil contaminated with infected feces.
• Drinking milk diluted with contaminated water.

There are certain factors that can increase the risk of typhoid fever. These include:

• Traveling to endemic areas: Some parts of the world are severely affected by typhoid. If possible, avoid traveling to these places, especially during the peak season of the disease.
• Poor hygiene habits: Hygiene plays a crucial role in preventing many diseases, including typhoid. Good hygiene practices, such as washing hands after using the toilet and before eating, can help prevent contracting typhoid.
• Consuming contaminated fruits and vegetables: Fruits and vegetables can become contaminated if washed with dirty water or grown in soil polluted by human excreta.
• Poor sanitation conditions: Exposure to contaminated environments and proximity to flying insects that can carry germs from feces increases the risk of typhoid.
• Close contact with a person having typhoid: Being in close contact with someone suffering from typhoid raises the risk of transmission.
• Healthcare workers: Healthcare workers are at the highest risk of infection, as they handle patients day and night, making it easier to contract the disease.
• Crowded housing with shared toilets: Individuals living in crowded areas with shared toilets are more susceptible to typhoid.

If anyone in your family suffers from typhoid or if you experience any signs and symptoms of typhoid fever, it is wise to consult a doctor. Your doctor will perform a physical examination and recommend several tests to diagnose the condition. Physical findings in the early stages may include:

• Abdominal tenderness
• Enlarged spleen and liver
• Enlarged lymph nodes
• Development of a rash (also known as rose spots due to their appearance)

However, clinical presentations may vary from person to person.

The laboratory investigations include:

1. Blood tests: This includes tests to detect IgM and IgG antibodies as well as blood culture tests to identify the bacteria Salmonella typhi.
2. Stool and urine analysis: To check for the presence of the bacteria in stool and urine samples.
3. Bone marrow culture: This test is recommended but rarely required, except in patients who have already received antibiotics and are not improving. It is one of the most sensitive tests for typhoid fever.
4. Widal antigen test: This test can be performed in two ways: slide agglutination and tube agglutination. Results are obtained after a waiting period of about 10 days. The conventional Widal test detects antibodies to S. typhi from the second week of symptom onset.
5. Typhi dot tests: These tests serve as a marker for recent infections and can detect early rising antibodies, predominantly IgM.

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Typhoid can be prevented by following good hygiene practices such as:

• Drinking only purified or mineral water.
• Always washing your hands with soap and water after using restrooms, and before eating or cooking food.
• Improving sanitation facilities or avoiding common unhygienic toilets.
• Maintaining optimum personal hygiene, such as avoiding sharing towels and other personal care items.
• Travelers should avoid drinking untreated water, adding ice to their drinks, and consuming roadside, uncooked, or unhygienic food.

Two vaccines are available for people traveling to areas where the risk of typhoid fever is high. One is administered as a single shot at least one week before travel. The other is given orally in four capsules, with one capsule taken every other day. Neither vaccine is 100% effective, and both require repeat immunizations as their effectiveness diminishes over time.

1. Antibiotic therapy
   Antibiotics are the first line and only effective treatment option for typhoid fever. In most areas, fluoroquinolones are the most effective drug of choice; however, they are increasingly met with resistance. Some commonly used fluoroquinolones include:
   • Ciprofloxacin
   • Amoxicillin
   • Trimethoprim-sulfamethoxazole
   • Chloramphenicol
   Due to increased resistance to ciprofloxacin, the newer drugs of choice are:
   • Azithromycin
   • Ceftriaxone
2. Vaccination prophylaxis
   The vaccine is recommended for those traveling to areas with a high risk of exposure. The World Health Organization Strategic Advisory Group of Experts on Immunization recommends the use of typhoid conjugate vaccines (TCVs) in India. It is administered as an intramuscular, single-dose vaccine for individuals aged 6 months and older.
3. Miscellaneous treatment
   This includes supportive and symptomatic care such as:
   • Maintaining adequate hydration during diarrhea
   • Ensuring proper ventilation and oxygenation for respiratory complications
   • Using analgesics and antipyretics to manage symptoms
   • Ensuring safe drinking water and following proper hygiene and sanitation

If typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed. Most people need to take antibiotics for 7 to 14 days.

Take ample amount of rest.

Drink plenty of fluids, such as:

• Purified water
• Coconut water
• Herbal teas
• Electrolyte solutions
• Clear soups

Eat light, healthy, nutrient-dense, and hygienic food that is easy to digest. A good nutritious balanced diet should include:

• High-calorie foods such as boiled potatoes, boiled rice, bananas, and porridge
• Water-rich fruits such as watermelons, grapes, muskmelons, and oranges
• Plenty of fluids such as purified water, fresh fruit juices, coconut water, lime water, buttermilk, and soups
• Dairy products such as milk, curd, and eggs

Avoid:

• Deep-fried, oily, and junk food, as it can cause stomach pain and bloating
• High-fiber foods such as whole grains and cereals
• Oily foods such as butter and fried foods
• Spices such as turmeric, chilies, vinegar, and pepper
• Raw vegetables like cabbage, capsicum, and radish

Maintain good standards of personal hygiene, such as regularly washing hands to reduce the risk of spreading the disease.

Keep in touch with your General Physician if new symptoms develop while being treated at home.

Complications caused by typhoid fever usually occur in individuals who have not received appropriate antibiotic treatment. Approximately 1 in 10 people experience complications, which typically develop during the third week of infection.

The two most common complications in untreated typhoid fever are:

• Internal Bleeding in the Digestive System
  Most internal bleeding associated with typhoid fever is not life-threatening, but it can cause significant discomfort. Common symptoms of internal bleeding include:
• Feeling tired all the time
• Breathlessness
• Pale skin
• Irregular heartbeat
• Splitting (Perforation) of a Section of the Digestive System
  Perforation is a potentially serious complication. Bacteria in the digestive system can enter the abdominal cavity and infect the lining, leading to peritonitis. The most common symptom of peritonitis is sudden abdominal pain that worsens progressively.

What Happens if Typhoid is Left Untreated?
If left untreated, and sometimes even after treatment, serious complications may arise, including:

• Pneumonia
• Meningitis (inflammation of the meninges of the brain)
• Osteomyelitis (infection in bones)
• Intestinal perforation
• Intestinal hemorrhage
• Inflammation of the heart muscle (myocarditis)
• Inflammation of the lining of the heart and valves (endocarditis)
• Inflammation of the pancreas (pancreatitis)

• Banana: Bananas can bring down the fever and treat diarrhea in individuals with typhoid. The pectin present in bananas is a soluble fiber that helps absorb liquid in the intestines, thus reducing diarrhea. Additionally, bananas have a high potassium content that balances the lost electrolytes during diarrhea and fever caused by typhoid.
  Tip: Eat 2 to 3 ripe bananas daily until your typhoid symptoms subside.
• Buttermilk: Drinking buttermilk is an excellent herbal treatment for typhoid fever. It is easy on the stomach and aids in recovery.
  Tip: Add 2 teaspoons of freshly extracted juice of coriander leaves to 1 cup of buttermilk. Drink this 2 times daily for 1 to 2 weeks.
• Cloves: Cloves are beneficial for treating typhoid fever. The essential oils in cloves have antibacterial properties, helping to fight the bacteria that trigger typhoid fever.
  Tip: Add 5 clove buds to plain water and boil until the volume reduces by half, strain, and drink for at least a week.
• Garlic: The antimicrobial properties of garlic help combat the bacteria that cause typhoid fever. It also boosts the immune system and aids in flushing out and killing the bacteria within the body.
  Tip: Consume 2 garlic cloves on an empty stomach for a couple of weeks to alleviate typhoid fever symptoms.
• Basil: Basil is another effective treatment for typhoid fever. This herb possesses antibiotic, immune-boosting, and antibacterial properties that can help eliminate the bacteria causing typhoid fever.
  Tip: Add 20 basil leaves and 1 teaspoon of crushed ginger to 1 cup of water and boil until the solution reduces by half. Add a little honey and drink this tea 2 to 3 times a day for several days.
• Homemade Oral Rehydration Solution (ORS): Fluid replacement is essential to replenish fluids lost through diarrhea and prevent dehydration. ORS will reduce the intensity of typhoid symptoms and aid recovery.
  Tip: Mix ½ small spoon of salt and 6 small spoons of sugar in 4 cups of clean drinking water and consume this solution until complete recovery.
• Apple Cider Vinegar (ACV): ACV has acidic properties and serves as a good home remedy for typhoid fever. It helps lower a high fever by drawing out heat from the body of the individual suffering from typhoid.

Typhoid, if diagnosed and treated timely, has a very good prognosis. Make sure to complete your antibiotic course as prescribed by your doctor.

Patients suffering from typhoid fever usually complain about gastrointestinal or digestive problems, such as loss of appetite. Eating small, healthy meals spread out during the day can help maintain energy levels.

Typhoid can also lead to weight loss. A high-calorie diet, including foods like boiled potatoes, sweet potatoes, and bananas, can help maintain body weight. Additionally, include protein-rich foods such as legumes, cheese, and yogurt in your meals. Avoid meat, spicy foods, and deep-fried items, as they may be difficult to digest.

High fever and diarrhea are major symptoms of typhoid, and both can lead to dehydration. To maintain body fluid requirements, one should consume plenty of fluids, such as purified water, fresh fruit juices, soups, and coconut water.