What are the other Names for this Condition? (Also known as/Synonyms)

• Abdominal Typhus
• Enteric Fever
• Infection by Salmonella Typhi

What is Typhoid Fever? (Definition/Background Information)

• Typhoid Fever (or simply Typhoid) is a bacterial infection caused by a micro-organism Salmonella typhi
• This infection is a tropical disease and as such, is rarely observed in the United States, Canada, and in European countries. In developing countries, the fever can cause significant mortality and morbidity
• An individual may contract the disease through contaminated food, water, or through contact with an infected individual
• A majority of the individuals with Typhoid recover fully, without any complications. However, a few may die from the disease

Who gets Typhoid Fever? (Age and Sex Distribution)

• Individuals of all ages may be infected by Typhoid Fever. Both males and females are equally susceptible
• The disease is especially observed among people, who live in the tropical (endemic) areas of Asia, Africa, and South America
• The disease is of particular concern to someone, who has traveled (from US/Europe) to an endemic area and returned home. In such cases, the signs and symptoms may not readily raise the suspicion of a Typhoid Fever, in western health care settings

What are the Risk Factors for Typhoid Fever? (Predisposing Factors)

Over 21 million people get infected with Typhoid Fever each year, according to Centers for Disease Control and Prevention (CDC). The chief endemic areas include South East Asia, Africa, India, and South America.

The risk factors of Typhoid include:

• Consuming food that is raw, or undercooked, or cooked improperly (without maintaining proper hygiene standards), or is not stored (refrigerated) well
• Drinking untreated water from a stream, or a well, or from any other unreliable source
• Living in, or travelling to, areas with poor sanitation facilities
• Living in, traveling to, or visiting tropical areas, where Typhoid is endemic
• Working in a microbiology lab that requires handling Salmonella typhi bacteria
• Caring for individuals, who are infected with the disease
• Individuals with decreased immune function, such as individuals on chronic steroidal therapy, those with HIV/AIDS

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Typhoid Fever? (Etiology)

Typhoid Fever (also called Enteric Fever) is caused by the bacterium Salmonella enterica typhi. It spreads through the fecal-oral route. An individual can get the disease through infected food, or contaminated drinking water.

• Occasionally, one may also get the condition through close contact with someone, who either has the infection, or is a chronic carrier of the disease
• Some individuals carry Salmonella typhi bacteria within their body, but do not show any signs and symptoms of the disease. These individuals are called chronic carriers
• Chronic carriers shed the bacteria in their feces. This has a potential to infect others or contaminate water, in areas/regions with poor standards of hygiene and sanitation

What are the Signs and Symptoms of Typhoid Fever?

Signs and symptoms of Typhoid Fever depend upon the stage of the illness. The stages of illness are generally classified as symptoms during the first week, the second week, the third week, and symptoms during the fourth week.

Symptoms during the first week of illness: The infected individual may experience

• Fevers, as high as 103-104°F
• Severe headaches, body aches
• Fatigue
• Abdominal pain
• Vomiting, nausea
• Diarrhea
• Reddish rashes, called purpura, are observed on the skin. These rashes appear on the chest and abdomen, and consist of reddish-brown flat circular lesions

Symptoms during the second week of illness: The infected individual may show

• Persistent high fevers
• Extensive diarrhea
• Constipation
• Abdominal pain
• Decreased body weight

Symptoms during the third week of illness: The infected individual may become

• Confused
• Lethargic
• Unresponsive to verbal commands

During the fourth week of illness, the fever may start to subside gradually. The individual’s body strength will gradually start returning to normalcy; he / she may start feeling better.

How is Typhoid Fever Diagnosed?

A diagnosis of Typhoid Fever would involve:

• A thorough and comprehensive physical examination
• Evaluation of clinical history, which includes a detailed travel history
• Blood cultures to isolate Salmonella typhi, testing of stools for bacterial antigens, and blood test to detect antibodies to the bacterium

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Typhoid Fever?

• Typhoid Fever infects the gastro-intestinal tract, usually the large intestine and causes an ulcer in the intestine. This ulcer may perforate or bleed, which may result in blood in the stools
• A perforated bowel (large or small intestine) may result in acute and severe abdominal pain
• Sometimes, the infection may spread into the blood stream, causing severe septicemia. This may result in infection of other body organs and cause life-threatening situations
• Septicemia may lead to death, if it is not treated promptly with appropriate antibiotic therapy

Occasionally, less frequent complications include inflammation of the following organs:

• Heart muscles (myocarditis)
• Lungs (pneumonia)
• Kidney
• Bones (osteomyelitis)
• Pancreas (pancreatitis)
• Inflammation of the membranes surrounding the brain (meningitis), may cause severe brain symptoms, such as confusion, convulsions, or even psychiatric illnesses

How is Typhoid Fever Treated?

Typhoid Fever is caused by a bacterium; hence, it can be treated using an appropriate antibiotic. However, due to extensive use of antibiotics, there is an increased resistance to antibiotics therapy by Salmonella typhi bacterium. The emergence of antibiotic-resistant bacteria has made treatment difficult. Hence, a judicious use of antibiotics is strongly recommended.

Ciprofloxacin in non-pregnant women and amoxicillin in pregnant women and children is generally recommended in western countries.

Supportive therapy may also help improve the patient’s general condition, such as:

• Fluid and electrolyte balance should be maintained though regular infusions
• A healthy diet (consisting of food less in fiber), is recommended during the illness and also during the recovery period

Note: Ciprofloxacin should not be given to pregnant women and children. It can have severe side effects on the developing fetus, in pregnant women. Also, the bone growth in children may be affected by ciprofloxacin.

How can Typhoid Fever be Prevented?

• To reduce the incidence of Typhoid Fever, proper precautions have to be taken to prevent transmission of the harmful bacteria via food and water. This is even more essential while traveling, to other endemic regions, cities, and countries
• Avoid undercooked food (especially meat and seafood) and contaminated water
• Avoid raw fruits and vegetables! Vegetables that cannot be peeled, such as lettuce, should be avoided
• In endemic areas, it is better to eat foods that are hot (heat kills the bacteria), rather than foods that are cold
• Follow basic rules while cooking food, such as carefully washing food items (like meat and vegetables), washing food vessels before use, cooking meat to the required temperatures to kill any bacteria, refrigerating cooked food to avoid it being spoiled, keeping food items covered, etc.
• Always drink water that is clean and is from a reliable source. If possible drink boiled water
• If you are visiting an endemic area, or if you are around somebody, who has been diagnosed with Typhoid Fever; then, frequent washing of hands is helpful
• Vaccinations are recommended for travelers to other parts of the world; those traveling to regions having high potential for such infections

Currently, there are vaccines available to provide a measure of protection against Typhoid Fever. These vaccines are helpful for individuals traveling to Typhoid-endemic areas.

• One kind of vaccine can be injected and is usually given in a single dose
• The other type of vaccine is usually given orally over a period of days
• It is important to note that both vaccines are not 100% protective against Typhoid Fever

What is the Prognosis of Typhoid Fever? (Outcomes/Resolutions)

• A majority of the individuals with Typhoid Fever get better in 14-30 days. They have a favorable prognosis with early treatment
• If the infection is severe, then prompt medical attention with appropriate antibiotics is necessary, which will prevent complications and improve the prognosis
• The infection should be more promptly treated in children and elderly individuals, who are at a higher risk to develop severe illnesses
• If severe symptoms are ignored, then it may result in severe organ damage. However, such organ damage rarely leads to death
• Occasionally, there may be a relapse because it was not properly eradicated, during the first episode. Chronic Typhoid Fever can be very debilitating

Additional and Relevant Useful Information for Typhoid Fever:

In many geographical (tropical) regions of the world (mainly the lesser industrialized nations), where the healthcare system lacks the kind of preparation and resources needed to treat the disease; the mortality rates due to Typhoid Fever is substantial.