Typhoid fever is an infection caused by a bacterium Salmonella typhi (S.typhi). It is a serious health threat in the developing world, especially for children.(1)
S. typhi is spread through contaminated food, drink, water or as a result of poor sanitation through faeco-oral route. The bacteria after entering your body travel into your intestines, and then into your blood. Through the blood to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.
S. typhi is passed in the faeces and sometimes in the urine of infected people, but some persons become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease. Hence typhoid may also spread by contact with the infected person.
Risk factors: you are at increased risk of getting typhoid infection if
Work in or travel to areas where typhoid fever is endemic
Work as a clinical microbiologist handling Salmonella typhi bacteria
Have close contact with someone who is infected or has recently been infected with typhoid fever
Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
Drink water contaminated by sewage that contains S. Typhi(5)
- The pulse rate is generally slow (relative bradycardia)
Rosy spots may appear on the lower chest and upper abdomen. These may appear in the second week.
- Abdomen: On examination, the abdomen shows tenderness and may be associated with enlarged spleen and liver.
Diagnosis is confirmed by identifying S. typhi in a culture of your blood or other body fluid or tissue. For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium and after 48 to 72 hours, it is studied under a microscope for the presence of typhoid bacteria.
In some instances other testing such as a test to detect antibodies to typhoid bacteria in your blood or a test that checks for typhoid DNA in your blood may be used.
Each of the test becomes positive at various times in the course of the disease like-
1. Blood culture in the 1st week (Bone marrow culture is better, but not commonly done)
In general, the course of the illness may vary as below: signs and symptoms more likely develop gradually 2014 often appearing one to three weeks after exposure to the disease but may be sudden in onset also.
1st week of illness
Once signs and symptoms do appear, you are likely to experience:
Fever, that starts low and increases daily, often to as high as 1030F or 1040F (39.40 or 400C)
Weakness and fatigue
Loss of appetite
Diarrhoea or constipation
2nd week of illness
If you don't receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience:
Continuing high fever
Either diarrhoea or severe constipation
Considerable weight loss
Extremely distended abdomen
3rd week of illness
By the third week, you may:
Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state
Life-threatening complications often develop at this time.
4th week of illness
Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.(2)
You will have to visit your doctor after 5-7 days of starting the antibiotics when you will be assessed for the reduction of the signs and symptoms of typhoid.
Again you will have to come to the hospital after 1 month. 3 consecutive stools tests will be done to rule out the carrier state of typhoid. If the test is negative then there is nothing to worry. If the test is positive then you will have to get the stool test done every month up to 1 year.
Call your doctor if:
You have had any known exposure to typhoid fever
You have been in an endemic area and you develop symptoms of typhoid fever
You have had typhoid fever and the symptoms return
You develop severe abdominal pain, decreased urine output, or other new symptoms(7)
If you feel well, normal life activities can be commenced within the next two weeks after completion of treatment which normally takes 10-14 days. But make sure you will not over exert yourself and do not get dehydrated.
1. Wash your hands - Wash your hands thoroughly with hot, soapy water, before eating or preparing food and after using the toilet. You can also carry an alcohol-based hand sanitizer for times when water isn't available
You have to take measures to prevent infecting others
If you are recovering from typhoid, these measures can help keep others safe:
1. Wash your hands often- Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
2. Clean household items daily- Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
3. Avoid handling food- Avoid preparing food for others until your doctor says you are no longer contagious. If you work in the food service industry or a health care facility, you may not be allowed to return to work until tests show that you are no longer shedding typhoid bacteria.
4. Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water.(4)
Tips for a good nutrition during typhoid fever are
A high energy, high protein, and a full fluid diet is recommended.
Have small meals at frequent intervals of 2-3 hours.
Have sufficient intake of fluids and salts.
Avoid whole grain, rice and other solid foods (they give pressure on your digestive system)
Avoid fat intake (put extra burden on the digestive process. Also cause vomiting which causes loss of further nutrients)
A high calorie diet includes- fruit juices with glucose, coconut water, barley water, porridge, rice ganjee and rava.
A high protein diet is recommended if there is no diarrhoea and includes-milk, custards, fruit milk shake, thin dal, eggs, soft cooked fish and chicken, mashed potato and other soft cooked vegetables and fruits like banana.