Enteric fever commonly known as typhoid is a clinical syndrome characterised by fever, headache, malaise and gastrointestinal symptoms. It is still one of the major health threats in developing countries like India.
How it is caused
It is caused by a bacteria- strains of Salmonella, S typhi (Typhoid Fever) and S Paratyphi (subtypes A, B and C). Contaminated food or water consumption or close contact with an infected person can cause Typhoid Fever. It spreads through the fecal-oral route. Typhoid carriers are people who do not have signs and symptoms of active disease but they still shed bacteria in their feces and are capable of infecting others. Once ingested through food or water, the bacteria reach the intestines and from there invade and multiply in the abdominal lymph nodes and spleen. Bacteremia-that is spread to the blood stream occurs and the infection then localizes principally in the lymphoid tissue of the small intestine. Intestinal ulcerations may occur in the third week of the disease. The bacteria may spread to the gall bladder, kidneys, lungs, or Brain.
Symptoms and Signs
Initially the patient complains of weakness, headache, cough and sore throat often with abdominal pain and constipation, while fever ascends Ina stepwise fashion. After about a week, patient is much more ill. There may be constipation or “pea soup” Diarrhea; abdominal distension as well. A rash( rose spots) commonly appears on the trunk during the second week. It disappears in 3-4 days. If there are no complications, the patient’s condition will gradually improve over 7-10days. However relapse may occur for upto 2 weeks after.
Complications occur in about 30% of untreated cases. Intestinal haemorrhage or intestinal perforation characterised by pain in abdomen and tenderness, sometimes accompanied by black stools, is most likely to occur in the third week. Pneumonia (lung infection) , Meningitis (inflammation of Brain membranes ), nephritis (kidney inflammation), cholecystitis (gall bladder inflammation), myocarditis (inflammation of the heart muscle), and osteomyelitis (bone involvement) that is involvement of various organs is possible but less often observed.
Typhoid fever is best diagnosed by blood culture which is positive on upto 80% of patients who have not taken antibiotics. Leukopenia or low white blood cells and raised liver enzymes or transaminitis are common laboratory findings.
Safe drinking water, improved sanitation, hand hygiene and adequate medical care can help prevent and control typhoid fever.
Multiple dose oral vaccine or single dose injectable vaccines are available. Boosters when indicated, should be given every 5 years and 2 years for oral and injectable vaccines, respectively. Neither of the vaccine is 100% effective. Therefore, it is imperative that hygiene is maintained for disease prevention.
Commonly prescribed antibiotics like Ciprofloxacin and Levofloxacin are prescribed for treatment of Salmonella infections. Injectable antibiotics Ceftriaxone May be needed for 10-14 days for severe infection. The prevalence of extensively resistant S typhi has emerged in South Asia including India in recent years. When an infection is caused by multi drug resistant strain, antibiotic according to culture and sensitivity is needed. Other treatment includes adequate hydration, supportive care, nutritional support. Surgery may be needed if there has been intestinal perforation due to typhoid complication.