Introduction:

Typhoid fever is a systemic infection caused primarily by the bacterium Salmonella enterica serotype Typhi and occasionally by Salmonella Paratyphi A, B, and C. It is a significant health concern in areas with poor sanitation and is characterized by fever, headache, constipation or diarrhea, rose-colored spots on the chest, and an enlarged spleen and liver.

Epidemiology:

• Incidence: Predominantly in developing countries with an estimated 11–20 million cases and approximately 128,000 to 161,000 deaths annually.
• Transmission: Fecal-oral route, through contaminated food and water.

Pathophysiology:

• Infection Cycle: Ingested bacteria survive gastric acid, multiply in the intestine, penetrate the intestinal mucosa, and enter the bloodstream, leading to bacteremia.
• Incubation Period: Usually 1–2 weeks after exposure.

Clinical Manifestations:

• Prolonged Fever: Can be high-grade and is typically step-ladder in nature, increasing daily.
• Gastrointestinal Symptoms: Abdominal pain, constipation or diarrhea, nausea, vomiting.
• Neurological Symptoms: Headache, confusion, delirium, known as "typhoid state."
• Rose Spots: Pink spots on the lower chest and abdomen, seen in some patients.

Diagnosis:

• Blood Cultures: The gold standard during the first week of illness.
• Stool and Urine Cultures: More likely to be positive after the first week.
• Widal Test: Serological test, less commonly used due to lower specificity and sensitivity.
• Bone Marrow Cultures: The most sensitive test, but less frequently performed.

Management:

• Antibiotic Therapy: Ciprofloxacin or azithromycin for non-resistant strains; ceftriaxone for multidrug-resistant strains.
• Supportive Care: Hydration, nutrition, and monitoring for complications.
• Vaccination: Available vaccines for travelers and individuals in endemic areas.

Complications:

• Intestinal Hemorrhage or Perforation: Due to necrosis of Peyer's patches.
• Encephalopathy: Altered mental status can occur in severe cases.
• Multi-organ Failure: Rare but can be fatal.

Prevention:

• Sanitation and Hygiene: Proper sewage treatment, handwashing, and safe food preparation.
• Vaccination: Recommended for travelers to endemic regions.
• Antibiotic Prophylaxis: For close contacts of an infected person in outbreak settings.

Prognosis:

• Untreated Cases: Mortality rate can be as high as 10–30%.
• Treated Cases: With prompt antibiotic treatment, the mortality rate drops below 1%.

Conclusion:

Typhoid fever remains a critical public health issue in areas with inadequate sanitation. Early diagnosis and appropriate antibiotic treatment are essential for a good prognosis. Preventive measures, including vaccination and improved sanitation practices, are crucial in controlling the spread of typhoid fever.

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