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Typhoid fever is a significant public health concern, especially in parts of Africa and South Asia, where it is endemic. This infection, caused by the bacterium Salmonella Typhi, mainly affects the gastrointestinal tract, and is characterized by high fever and abdominal pain. The disease typically spreads through contaminated food and water, though it can also be transmitted through close contact with infected individuals. Prompt treatment with antibiotics is crucial and can alleviate symptoms within a week. While vaccines provide a degree of protection, they do not prevent all Salmonella-related infections. Without timely intervention, typhoid fever can lead to severe complications.
Symptoms
Symptoms of this illness typically develop gradually, often appearing 1 to 3 weeks following exposure to the causative bacteria.
Early stage symptoms:
- Fever that begins low and escalates throughout the day, potentially reaching up to 104 degrees Fahrenheit (40 degrees Celsius).
- General weakness and fatigue.
- Diarrhea or constipation.
- Chills.
- Headache.
- Muscle pains.
- Abdominal pain.
- Skin rash.
- Additional possible symptoms include cough, decreased appetite, and sweating.
Later stage symptoms:
- Persistent abdominal pain.
- Noticeably swollen abdomen.
- Sepsis, which is a widespread infection caused by the spread of gut bacteria throughout the body.
Severe complications: These complications are considered life-threatening:
- Confusion and disorientation.
- Inability to focus or engage with surroundings.
- Unresponsiveness to external stimuli.
Recurring symptoms: In some cases, symptoms might reappear a few weeks after the initial fever subsides.
Immediate medical consultation is recommended if there’s a suspicion of typhoid fever. During international travel, it’s important to know who to contact for medical assistance, often available through the nearest embassy or consulate. Upon returning home, consider visiting a healthcare provider specializing in infectious diseases or travel medicine to ensure prompt and accurate diagnosis and treatment.
Causes
Typhoid fever is caused by a bacterial strain known as Salmonella enterica serotype typhi, whereas similar diseases like paratyphoid fever are caused by other salmonella strains.
Common modes of transmission:
- Human contact: People often contract the bacteria in regions prone to outbreaks. The bacteria exit the body through the stool and urine of infected individuals. If someone doesn’t wash their hands thoroughly after using the restroom, the bacteria can transfer from their hands to surfaces or other individuals.
- Food and water: The bacteria can also spread via food that isn’t adequately cooked, particularly raw fruits that aren’t peeled. Additionally, in areas where water isn’t treated, people can contract the bacteria through drinking water, using ice made from untreated water, or consuming unpasteurized milk or juice.
Chronic carriers
A small percentage of individuals who recover from typhoid fever become chronic carriers. Even though they no longer exhibit symptoms, they continue to carry and shed the bacteria in their stools, posing a risk of spreading the disease.
Risk factors
Typhoid fever is predominantly prevalent in rural regions of developing nations where modern sanitation infrastructure is lacking. As a result, countries across South and Southeast Asia, Central and South America, Africa, and the Caribbean are at higher risk of experiencing outbreaks. Children are particularly vulnerable to the disease compared to adults.
Other risk factors include:
- Come into close contact with an individual who has typhoid fever or who has recently contracted the illness.
- Travelers visiting places like Pakistan, India, or Bangladesh are at higher risk of getting typhoid
- Working with Salmonella enterica serotype typhi bacteria as a clinical microbiologist
Diagnosis
Diagnosing typhoid fever entails a comprehensive process that includes symptom assessment, review of travel history, physical examination, and the administration of various diagnostic tests.
Tests that may be required include:
- Tissue or body fluids test: A healthcare provider might collect various body fluid or tissue samples to check for S. Typhi, the bacterium responsible for typhoid fever. If the bacteria that cause typhoid fever are present, they will multiply and can be seen under a microscope. A culture test where a sample of the blood, stool, urine, or bone marrow is often used. Bone marrow culture is the most accurate among these.
- Imaging tests: X-rays may be required to examine the lungs for any unusual changes.
Treatment
Typically, typhoid fever is managed with antibiotics, complemented by interventions to prevent dehydration and manage any complications that may arise. Adequate fluid intake is essential to maintain hydration, with intravenous fluids necessary in cases of severe dehydration. In instances where the illness results in intestinal damage, surgical intervention may be necessary to address the issue. Antibiotic resistance among some bacterial strains underscores the importance of tailoring antibiotic treatment based on the individual’s location of infection and the specific type of typhoid contracted.
Frequently recommended antibiotics: Certain antibiotics affect strains differently depending on where they were acquired. Medications that may be prescribed in combination or alone include:
- Fluoroquinolones: Although some bacteria can withstand these drugs, which is known as antibiotic resistance, these are still effective in treating infections because they prevent bacteria from replicating. Fluoroquinolones, such as ciprofloxacin, are often the first antibiotics that are prescribed for treatment.
- Macrolides: Antibiotic resistance may be addressed with one type of medication called azithromycin. Antibiotics in this class prevent bacteria from producing proteins.
- Carbapenems: When treating severe infections that fail to improve with other antibiotics, this medication may be prescribed. These antibiotics stop bacteria from forming cell walls.
- Cephalosporins: Ceftriaxone, a type of antibiotic in this group, is often used when bacteria have become resistant to other antibiotics. This group of antibiotics works by stopping bacteria from making cell walls, which are crucial for their survival.
