Typhoid Fever
Typhoid fever is an acute infectious disease caused primarily by the bacteria Salmonella typhi. In some instances, it may also be attributed to Salmonella paratyphi, which is often associated with a milder form of the illness compared to that caused by Salmonella typhi. Current estimates indicate that between 11 to 20 million individuals are infected with typhoid fever globally, leading to approximately 128 to 161 deaths each year. Factors such as urbanization and climate change can exacerbate the global burden of typhoid, along with increasing antibiotic resistance and ineffective sanitation systems, which facilitate the disease’s spread in densely populated areas.
Mechanism of Typhoid Fever Development
Typhoid fever transmission occurs through the consumption of food or beverages contaminated with the responsible bacteria, which can survive for weeks in water or dry sewage. Notably, around 3-5% of individuals who experience acute infection may become carriers of the bacteria, sometimes without displaying significant symptoms. This prolonged asymptomatic state can contribute to the spread of typhoid fever for many years. The progression of the illness can be outlined according to the stages of infection as follows:
Weeks One and Two
The incubation period lasts approximately 10 to 14 days, with early symptoms of typhoid fever including:
- Headache.
- Malaise.
- Generalized body aches.
- Loss of appetite.
- Nosebleeds.
- Cough.
- Diarrhea.
- Constipation.
- Insomnia impacting sleep quality.
- Fever, which gradually intensifies, peaking around days 7 to 10 with temperatures reaching 39-40 degrees Celsius. The fever may persist longer but at lower intensities if untreated.
By the second week, the bacteria proliferate significantly in the bloodstream, often accompanied by a rash characterized by small pink spots on the trunk, lasting approximately 4 to 5 days before fading. As the bacteria multiply, they can cause inflammation of the lymphatic follicles along the intestinal wall, leading to necrosis of these follicles and ulceration within the intestinal walls. It is noteworthy that dying intestinal tissue can erode blood vessels, resulting in bleeding or perforation of the intestinal walls, which can cause intestinal contents to enter the peritoneal cavity. This situation significantly raises the risk of severe complications such as acute cholecystitis, heart failure, pneumonia, osteomyelitis, encephalitis, or meningitis. With sustained fever, symptom severity escalates, and patients may experience mental disturbances and delirium.
Week Three
By the end of week three, several symptoms become more pronounced, including weight loss and abdominal disturbances alongside mental health symptoms. The fever may start to decline in some cases, and symptoms often begin to abate as the fourth week progresses. Timely treatment for typhoid fever is crucial since untreated cases can result in a mortality rate of 10-30%, whereas this rate drops to about 1% with appropriate treatment. It is also important to consider potential for severe, long-term complications related to typhoid infection in patients with certain underlying conditions, such as cancer or sickle cell anemia.
Treatment of Typhoid Fever
Home Treatment
In cases of early detection, typhoid fever is typically managed with a course of antibiotics lasting 7 to 14 days. Patients generally notice symptom improvement within 2 to 3 days of initiating antibiotic treatment. It is crucial to complete the entire antibiotic course as prescribed to prevent symptom recurrence. Treatment also includes maintaining adequate hydration and ensuring sufficient rest, as well as adhering to a regular meal schedule.
Hospital Treatment
In more severe cases, where patients experience persistent nausea, severe diarrhea, or abdominal distension, hospitalization is recommended. Treatment in this setting often involves intravenous antibiotics, fluids, and nutritional support. Surgical intervention may be necessary in the presence of life-threatening complications. Most patients respond well to treatment within 3-5 days; however, the recovery process may take several weeks before discharge from the hospital.
Management of Carriers
Individuals who are carriers of typhoid infection should notify relevant health authorities and must refrain from food preparation or cooking until lab tests confirm the elimination of the bacteria. Carrier management often requires a course of antibiotics lasting 4 to 6 weeks to eradicate the bacteria.
Prevention of Typhoid Fever
Preventing typhoid fever involves following several precautions, including:
- Receiving the typhoid vaccine, available as either capsules or injections, with a healthcare provider determining the most suitable option for the individual.
- Ensuring proper water purification before using it for drinking, washing, food preparation, ice-making, or brushing teeth.
- Cooking food thoroughly, avoiding purchases of items from street vendors, and steering clear of foods that are improperly stored or served at room temperature.
- Avoiding consumption of unpeeled raw fruits and vegetables washed with contaminated water.
- Practicing thorough hand hygiene by washing hands with soap and clean warm water, especially after using the restroom and before eating or preparing food.