In the United States, there are about 6,000 annual cases of typhoid fever or typhoid. About three-quarters of these cases are contracted when American inhabitants travel abroad. If caught early, these cases can be successfully treated using antibiotics. However, in developing countries, typhoid is a common threat.
Definition & Facts
Typhoid is an acute illness that is characterized by fever and is caused by bacteria known as Salmonella typhi (S. typhi). The infection can also be caused by related bacteria known as Salmonella paratyphi that often cause a less severe illness. The bacteria are deposited on food or water by a human carrier and then spread through the fecal-oral route to other people in the surrounding areas.
Since the 1900s, the incidence of typhoid fever in the US has remarkably reduced. This improvement is attributed to better sanitation standards. But, countries like Egypt, Pakistan and India are known to be high-risk areas for typhoid. Globally, the typhoid fever affects over 21 million individuals annually, and about 200,000 people die from this disease.
Symptoms & Complaints
- Abdominal tenderness
- Blood in stool
- Attention deficit (difficulty paying attention)
- Mood fluctuation
- Severe fatigue
- Lethargy and sluggishness
S. typhi is spread through contaminated water and contaminated food. If an individual eats or drinks something that is contaminated with the bacteria, the bacteria enter the body. The bacteria travel into the intestines, and then into the blood. They travel through the blood to the lymph nodes, liver, spleen, gallbladder, and other parts of the body.
Infected people urinate and defecate living bacteria in their urine and feces. They are often contagious for several days before any symptoms of the disease set in and don’t know they need to take extra precautions.
Without proper hand washing, the typhoid bacilli can be transferred to water and food, and from there, to other people. They can also be spread from one individual to another through contaminated fingers. Close to 4 percent of the people, whether treated or not, become asymptomatic carriers of the S. typhi. This means they continue to shed the bacteria in their excrement for at least a year, and often throughout their lives, but these people don’t have any symptoms of typhoid.
Every country has a small number of typhoid carriers. Even the US and Canada report tens of locally transmitted typhoid cases annually though most of these cases are among immigrating or traveling people who are infected when they arrive.
Diagnosis & Tests
After ingesting contaminated water or food, the S. typhi invade the small intestines and temporarily get access to the bloodstream. The bacteria are transported by white blood cells to the bone marrow, spleen, and liver where they multiply and again enter the bloodstream. At this point, people develop symptoms.
The bacteria invade the biliary system, gallbladder, and lymphatic system of the bowel. They then multiply in large numbers. These bacteria enter the gastrointestinal tract and can be identified in stool samples. If the test results are unclear, blood samples can be used to make the diagnosis. The complete blood count (CBC) shows a high number of white blood cells. A blood culture done in the first week after the fever can show the S. typhi bacteria. Other tests that can help in the diagnosis include:
- ELISA urine test to look for the S. typhi bacteria
- Direct fluorescent antibody study to check for bacteria-specific substances
- Platelet count—the platelet count may be low
- Stool culture
Treatment & Therapy
The patient may be given electrolytes and fluids intravenously (IV). One may also be asked to drink pure water with electrolytes. A sick individual is usually given antibiotics to kill the bacteria. Currently in the world, there are increasing cases of antimicrobial resistance. Thus, the healthcare provider will refer to current recommendations before prescribing antibiotics.
The antibiotics given include ciprofloxacin, ceftriaxone, and levofloxacin. These medications usually remove the symptoms within a week. However, people with severe typhoid may be given glucocorticoids like dexamethasone. If properly treated, very few people die of typhoid, but they are still likely to be infectious for at least eight days after the symptoms subside.
Some people may remain infectious and keep excreting the bacteria in their stool for about three months or more. However, this state is unlikely to occur except when such a person has gallbladder disease.
Prevention & Prophylaxis
- When traveling, individuals should only drink bottled or boiled water, and eat food that has been sufficiently cooked
- Waste disposal, water treatment, and protecting food from contamination are vital public measures that people must take.
- Typhoid carriers must not be allowed to serve as food handlers
- Careful hand washing before food handling and after bowel movements will help in preventing the spread of enteric fever
- Disinfect or boil water before drinking it. There are many disinfectant liquids and tablets available in most pharmacies
- Peel vegetable and fruit skins before eating
- Keep flies away from food
- Avoid foods or drinks from street vendors
Typhoid fever is an acute disease that, if left untreated, can be fatal. Thus, everyone is advised to be cautious, especially when traveling abroad, to prevent contracting the disease by following the recommended advice.