Overview
Typhoid fever, also known as enteric fever, is an infection caused by the salmonella bacteria. It is a serious health threat, especially for children, in places where it is more common, such as Africa and South Asia. Typhoid fever can be contracted through contaminated food and water or by close contact with a person carrying the bacteria. Symptoms include high fever, headache, stomach pain, and either constipation or diarrhea. In some cases, the infection can also cause inflammation of the membranes surrounding the brain and spinal cord (meningitis) and psychiatric problems, like delirium and hallucinations. Typhoid fever can be prevented by getting vaccinated, accessing treated water, and practicing proper hand-washing. If you think you may have typhoid fever, it is important to see a healthcare provider immediately for proper diagnosis and treatment.
Understanding the disease
Symptoms
The symptoms of typhoid fever include high fever, headache, stomach pain, constipation or diarrhea, weakness and fatigue, muscle aches, and rash. These symptoms typically begin to appear 1 to 3 weeks after exposure to the bacteria.
Risk Factors
Risk factors for developing typhoid fever include:
- Living in or traveling to areas where the bacteria causing typhoid fever is common, particularly in Africa and South Asia.
- Working as a clinical microbiologist handling Salmonella enterica serotype typhi bacteria.
- Having close contact with someone who is infected or has recently been infected with typhoid fever.
- Consuming contaminated food or water, such as raw fruits without a peel, unpasteurized milk or juice, or ice made from untreated water.
- Poor sanitation and hygiene practices, such as inadequate waste management and hand-washing after using the restroom. Note that the risk factors are specific to the transmission and prevalence of typhoid fever, and not the risk factors for developing the disease itself.
Development
Typhoid fever is caused by a bacteria strain called Salmonella enterica serotype typhi. The bacteria is usually spread through contaminated food or water, or through close contact with a person who is carrying the bacteria. The bacteria passes out of the body in the stool and urine of infected individuals, and can spread if proper hand-washing practices are not followed. In some cases, the bacteria can also be spread on raw fruits or other foods that are not properly cooked. Typhoid fever is a serious threat in places where it is more common, such as Africa and South Asia. People who have recently traveled to these areas or who work in microbiology are also at an increased risk. Chronic carriers, who have recovered from typhoid fever but still have the bacteria in their bodies, can also spread the disease.
Assessment and Diagnosis
Triage
You should see a health care provider right away if you think you might have typhoid fever. Symptoms include high fever, headache, stomach pain, constipation or diarrhea. If you get sick while traveling in a foreign country, know who to call for a list of providers. If you have symptoms after you return home, consider seeing a provider who focuses on international travel medicine or infectious diseases. This might help get typhoid fever diagnosed and treated more quickly.
Diagnosis
To diagnose typhoid fever, your health care provider may suspect the illness based on your symptoms and medical history. The most common diagnostic test is a culture test, which involves taking a sample of your blood, stool, urine, or bone marrow and checking it for the presence of Salmonella enterica serotype typhi bacteria. Antibiotic therapy is the only effective treatment for typhoid fever, and the specific antibiotics used may depend on where the bacteria was acquired. It's important to inform your health care provider of any recent international travel or exposure to possible sources of infection.
Management and Treatment
Complications
Typhoid fever is caused by the bacteria Salmonella enterica serotype typhi, and it can lead to several complications. Damage to the intestines is one of the potential complications, which can cause severe stomach pain, vomiting, and infection throughout the body called sepsis. Other possible complications include:
- Sepsis
- Inflammation of the heart (endocarditis)
- Inflammation of the lining surrounding the heart (pericarditis)
- Inflammation of the brain (meningitis)
- Kidney problems
- Gallbladder and liver problems
- Nervous system problems, such as delirium or confusion These life-threatening complications require immediate medical care.
Prevention
typhoid fever can be prevented through various measures:
- Vaccination: Two vaccines are available for people aged 2 and older. One is given as a single shot at least one week before travel, while the other is given orally in four capsules, with one capsule to be taken every other day.
- Access to treated water: In areas where typhoid fever is common, using treated water can help avoid contact with the Salmonella enterica serotype typhi bacteria.
- Management of human waste: Proper management of human waste also helps prevent the spread of the bacteria.
- Hand-washing: Frequent hand-washing with hot, soapy water is crucial in controlling the infection. This should be done for at least 30 seconds before eating and after using the toilet. Carrying an alcohol-based hand sanitizer is helpful when soap and water are not available.
- Avoiding untreated water: Drinking only bottled water or canned/bottled carbonated beverages, wine, and beer is recommended. Avoid using untreated water for brushing teeth or drinking in the shower. By following these guidelines and practicing good hygiene, you can reduce the risk of contracting typhoid fever while traveling to high-risk areas.
Treatment
The most effective treatment for typhoid fever is antibiotic therapy. Commonly prescribed antibiotics for typhoid fever may include azithromycin, amoxicillin, or ciprofloxacin. The choice of antibiotic may depend on the severity of the infection and the bacterial strain responsible. It is important to consult a healthcare provider for a proper diagnosis and appropriate treatment plan.
Preparing for medical consultation
To prepare for an appointment for typhoid fever, you should gather the following information and be ready to provide it to your healthcare provider:
- Symptom history: Write down any symptoms you're experiencing and for how long.
- Recent exposure to possible sources of infection: Be prepared to describe international trips in detail, including the countries you visited and the dates you traveled.
- Medical history: Make a list of your key medical information, including other conditions for which you're being treated and any medications, vitamins, or supplements you're taking. Your provider also needs to know your vaccination history.
- Questions to ask your healthcare provider: Write down your questions in advance to make the most of your time with your provider. Some possible questions to ask include:
- What are the possible causes for my symptoms?
- What kinds of tests do I need?
- Are treatments available to help me recover?
- How long do you expect a full recovery will take?
- When can I return to work or school?
- Am I at risk of any long-term complications from typhoid fever?
- Other treatments: Be aware that other treatments may include drinking fluids to prevent dehydration, surgery if the intestines are damaged, and antibiotics prescribed by your healthcare provider. Remember to be honest and open with your healthcare provider about your symptoms and medical history, so they can provide appropriate care and guidance.