A Guide to Identify and Treat Typhoid in the Early Stages

Typhoid fever is a bacterial infection spread through contaminated food or water. It can cause severe illness and even result in death if left untreated. This disease is caused by the bacteria Salmonella Typhi. Once salmonella typhi is ingested, it can multiply and spread in the bloodstream. Hence, early detection and treatment are vital for successful recovery. Symptoms of typhoid can include high fever, diarrhoea and vomiting. The prevalence of typhoid is prominent in areas where there is poor hygiene and sanitation.

Through this guide, we will discuss the early signs of typhoid, how to manage typhoid symptoms, avail prompt treatment and the preventive measures to keep in mind to avoid contracting and spreading this disease

Understanding Typhoid Fever- Causes, Risk Factors and Medium of Transmission

One of the key typhoid symptoms is fever. Typhoid is an infection caused by the Salmonella typhi bacteria. People often contract these diseases in areas where outbreaks are common. This strain of bacteria passes out of the body through the urine and faecal matter of people who carry this bacterium. Improper hand washing after using the bathroom can result in bacteria getting transmitted from hands to objects and  other people.

Close contact with an infected person can also result in the contraction of typhoid. It spreads primarily through food, water, fruits and vegetables contaminated with infected faecal matter. This disease can also spread in areas where water is not treated to kill germs. Washing fruits and vegetables with contaminated water, using ice made with untreated water, and drinking unpasteurised milk are other causes which can transmit typhoid.

In India, typhoid symptoms are easily detected since it’s an age-old disease going all the way back to the 1880s.

•  Transmission of Typhoid

Typhoid spreads typically through direct contact with the faeces of an infected person. Animals do not carry this disease. Hence, transmission is always from one human to another.

• Risk Factors for Typhoid

Typhoid fever affects millions of people worldwide every year. In areas where there is water treatment to kill germs and human waste disposal is managed effectively, typhoid fever cases are rare. However, this disease continues to be a health threat in developing areas of Africa, the Americas, Southeast Asia and the Western Pacific Regions. According to the WHO, there are about 11–20 million typhoid fever cases globally, which results in 1,28,000-1,61,000 deaths per year.

Typhoid cases are more common in populations that lack access to safe treated water and adequate sanitation. Impoverished communities and vulnerable groups, especially children, are at higher risk.

• Who is at Risk for Typhoid?

People living in areas with the highest number of cases or regular outbreaks, such as South Asia and Africa, are at a higher risk of getting typhoid fever.

However, even if you live in countries where typhoid-related infections are rare, you will still be at risk:

If you work in or travel to places where typhoid infections are more widespread

If you work as a clinical microbiologist

Have close contact with someone who is infected or has been recently infected with typhoid fever

Local outbreaks can happen in the food industry where a person who is a carrier of this disease transmits it through food. Even though it’s rare, people who work in restaurants or other food-related businesses can be at a high risk and show typhoid fever symptoms.

Typical Signs and Symptoms of Typhoid Fever

The symptoms of typhoid fever generally develop 1 to 2 weeks after a person is infected with Salmonella Typhi bacteria.

• Early Symptoms of Typhoid Fever Include:

Mild fever

Chills that involve body shaking or shivering as a response to fever

Headaches

Weakness and fatigue

Muscle ache

Stomach pain

Diarrhoea or constipation

 Loss of appetite

General feeling of malaise or restlessness

• Later Symptoms of Typhoid Fever Include:

Fever that starts slowly and increases throughout the day and can reach even as high as 104 degrees Fahrenheit

Intense headache

Delirium or an acute state of confusion that could be a direct physiological result of the medical condition

Abdominal pain and cramping-The abdomen may be distended at this stage and one may experience pain

The spleen and liver may appear enlarged and tender

Dehydration ensues along with malnutrition

Rashes or Rose spots may appear, which are small red spots on the abdomen and chest.

Bradycardia, which refers to a slow resting heart rate

Weakness and exhaustion

Diarrhoea occurs at this stage, but even constipation is commonly seen

Typhoid Fever Diagnosis- Tools and Techniques

It is recommended that you visit your doctor if you think you have typhoid fever, especially if you have returned after travelling abroad in the past month or so.

Your doctor will want to know whether you have travelled in areas where the disease is prevalent and where there have been known outbreaks. They will also want to know whether you have been in close contact with someone who has travelled to such areas.

• Diagnostic Tests for Typhoid Fever

A doctor can confirm the diagnosis of typhoid fever by a sample of urine, stools or blood.

However, the bacteria may not always be detected in the first go, requiring you to undergo a series of tests e.g. Widal, Typhidot etc

Testing a sample of bone marrow is a more accurate method of detecting the bacteria. But this can be painful and time-consuming and is recommended only if the other tests are inconclusive.

• Differential Diagnosis of Typhoid Fever

Due to its non-specific symptoms, typhoid can mimic other infectious diseases with similar clinical presentations. Therefore, a broad diagnosis needs to be considered, especially with diseases characterised by symptoms like diarrhoea, dysentery, abdominal distension, fever, splenomegaly, and shock. Hence, all these aspects should be considered in the appropriate clinical context for accurate diagnosis and treatment.

Some common diseases like dengue fever, malaria, amoebiasis, tuberculosis etc. can mimic typhoid-like symptoms.

• When to See a Doctor

See your doctor as soon as possible if you experience symptoms of typhoid fever (even if you have been vaccinated against it), especially if you have returned from an international trip.

Although it is unlikely that your symptoms are caused by typhoid fever, it is advisable to seek medical help to rule out any health concerns and determine whether you need treatment or not.

H2-4: Treating Typhoid Fever

• Medications for Typhoid Fever

The only effective treatment for typhoid is antibiotics.

• Effective additional Home Remedies for Quick Recovery

Ensure you get enough rest, drink plenty of fluids and eat regular meals. Instead of eating three large meals, it would be better to consume five smaller meals.

Maintain good hygiene standards by frequently washing your hands with soap and water to reduce the risk of spreading the infection to other family members.

•  When to Seek Medical Help
• Contact your doctor as soon as possible if your symptoms worsen or you develop new symptoms while undergoing treatment at home.

Some people can have recurring symptoms, also known as a relapse. Do visit your doctor if your symptoms return after the treatment.

Prevention of Typhoid Fever

Typhoid fever is common in areas with poor sanitation and no access to safe drinking water. Provision of safe drinking water, adequate sanitation, hygiene practices followed by food handlers and timely typhoid vaccination are all effective ways to prevent typhoid fever.

• Vaccines for Typhoid Fever

There are two main vaccines available to prevent typhoid fever:

Vi Vaccine: This is a single injectable vaccine for people aged over two years

Ty21a Vaccine: Given as three capsules to be taken on alternate days for people aged over five years.

These vaccines work by triggering your body to produce antibodies that prevent you from falling ill if infected by typhoid bacteria.

Remember that neither vaccine is 100% effective; hence, take precautions while consuming food and water more so on your foreign trips.

• Hygiene Practices to Prevent Typhoid Fever

Frequent handwashing with water and soap like is the best way to control infection. Ensure you wash your hands before eating or making food and after using the toilet

Proper sanitation facilities like hygienic living conditions and efficient sewage disposal systems can keep this disease at bay.

• Travel Precautions for Typhoid Fever

Typhoid vaccinations should be mandatory for all those travelling to areas with a high risk of typhoid fever. Additionally, following some basic practices while travelling to places where typhoid fever is present, is essential.

Always ensure food is well cooked and still hot when served.

Avoid raw milk and its products and opt only for pasteurised or boiled milk.

Avoid adding ice to your drinks until you are sure it's made of safe water.

Drinking clean and safe water is crucial to prevent typhoid fever. Drink bottled or boiled water or make use of a water filtration system

Avoid raw foods and vegetables as they could have been washed with contaminated water. Always wash fruits and vegetables thoroughly with clean water before consumption. If possible, eat only peeled fruits and vegetables.

Potential Complications of Typhoid Fever

The symptoms of typhoid fever may get complicated if not treated with appropriate antibiotics and in the absence of timely medical intervention.

In such situations, about 1 in 10 people exhibit complications usually visible in the third week of the infection.

Some common complications in untreated typhoid fever include:

• Intestinal Bleeding

Intestinal bleeding that happens with typhoid fever need not necessarily be life-threatening, but it can make you feel very ill. A blood transfusion can help replenish the lost blood, and surgery at the site to stop the bleeding.

• Perforation

Perforation can prove to be a severe health complication. This is because it can lead to the bacteria in your digestive system moving and infecting the lining of your abdominal cavity(peritoneum). It is also called peritonitis, which causes the infection to spread rapidly in your blood and organs. A common symptom of peritonitis is sudden abdominal pain, for which you will require treatment with antibiotic injections at the hospital. The mainstay of treatment is Surgery to seal the hole in the intestinal wall.

• Encephalopathy

Typhoid encephalopathy is another complication that is seen and it has a 55% mortality rate. Encephalopathy is a condition that can result in temporary or permanent brain damage, disorder or disease. It can affect the functioning of the brain and may be degenerative.

• Long Term Effects of Typhoid Fever

Untreated typhoid fever can cause the above complications, including delirium, obtundation and even death within one month of its onset. Some people may be left with long-term or permanent neuropsychiatric complications.

Even after your symptoms have passed, some people may still have traces of the bacteria in their stools, indicating they have become carriers of this infection. The bacteria have the ability to survive for 12 months or more in your body after you were first infected. A course of antibiotics for 28 days should help to flush out the bacteria

Final Thoughts on Typhoid

• Summary of Typhoid Fever Symptoms

The bacterium salmonella typhi causes typhoid fever. The symptoms of typhoid can include high fever, weakness and exhaustion, headache, abdominal pain, diarrhoea and constipation, loss of appetite and sometimes even a rash on the body. If left untreated, the disease can lead to adverse health concerns like internal bleeding, haemorrhaging and perforation of the intestine.

• Importance of Early Detection and Treatment

Early detection and treatment are vital for quick recovery, reducing complications, and preventing disease spread and antibiotic resistance. It is essential to seek medical help if you suspect typhoid fever.

• Tips for Prevention of Typhoid Fever

One of the most effective ways of treating typhoid is to get vaccinated. The typhoid vaccination can be taken as an injection or an oral medication. Other preventive measures to keep in mind are frequent handwashing, drinking clean and safe water, avoiding raw foods and vegetables. Availing proper sanitation facilities, hygienic living conditions and efficient sewage disposal system, can help keep this disease at bay.