What is Typhoid?
Typhoid is an enteric fever caused by Salmonella typhi and Salmonella paratyphi. Enteric fever is a common term used to describe Typhoid and paratyphoid fever.
Paratyphoid and Typhoid fever have no major difference in clinical significance, so the term enteric fever is used. People who live in crowded and unhygienic places get affected by Typhoid fever. It is one of the major causes of mortality and morbidity.
The course of infection ranges from gastrointestinal distress to non-specific systemic illness, which ultimately leads to multiple complications. The bacteria that causes Typhoid is Salmonella which belongs to the Enterobacteriaceae family. The Salmonella is the genus and the species are Salmonella enterica serovar and Salmonella enterica enteritidis. The infection spreads through four F’s— fingers, flies, faeces and fomites.
The onset of fever can be seen after three days of infection, and there will be a rise and fall in temperature—a major Typhoid symptom. Other prominent symptoms like abdominal pain and headache are also experienced by a person affected with Typhoid.
The species of Salmonella typhi and Salmonella paratyphi (A, B, C) are serotypes of Salmonella enterica. Salmonella infection spreads through contaminated water, undercooked raw foods like poultry and red meat and poor sanitation. It also spreads through an infected person’s faeces and fomites.
Salmonella’s hosts are only humans, so it spreads from one person to another. The major sources of Salmonella are eggs, poultry and sometimes turtle. The gut flora can fight against the infection, but when antibiotics are taken, these gut flora can reduce and increases the chances of infection. Broad spectrum antibiotics and poor nutrition can also be one of the reasons for the infection.
According to a research paper published in NCBI, it stated that about 4% of people affected with Typhoid become chronic carriers. After the treatment, patients with Typhoid remain asymptomatic and may excrete Salmonella in their stools for up to a year.
Women are more susceptible to Typhoid fever when they have biliary abnormalities and cholelithiasis. Blood group antigens are also susceptible to becoming chronic Salmonella carriers.
Symptoms of Typhoid
The Typhoid symptoms depend on factors like age, type of infection, virulence and the host’s immunity. However, there are certain common symptoms that people might exhibit.
High fever
Typhoid fever can be very severe in people whose immunity is compromised. The onset of fever happens after three days of infection. There will be a rise and fall in temperature. During the course of antibiotic intake, the symptoms may settle in.
Headache
Headache is one of the prominent symptoms of Typhoid fever. A high fever will accompany a headache. However, other neurological symptoms like acute psychosis, myelitis, sleep irregularities, muscle rigidity and focal neurological deficits are also reported.
Stomach pain
Typhoid fever mainly affects the stomach and its organs. Typhoid fever affects the spleen, and abdominal pain is also a common symptom.
Constipation
People affected with Typhoid fever experience constipation or diarrhoea.
Diagnosis of Typhoid
Certain medical procedures can make the diagnosis of Typhoid.
Medical
When a person exhibits certain symptoms, a doctor makes a diagnosis and confirms whether the infection is Typhoid or not. The doctor will also enquire about your travel history to trace the place of infection.
Body fluid
Typhoid diagnosis is made through body fluids like stools, urine and blood test. The collected sample from the patient is tested on a special medium that encourages the growth of the microorganism.
The medical diagnosis and body fluid test are generalised diagnoses. However, to confirm the presence of Salmonella species certain, a blood test and culture test is required.
Exams and Tests
The diagnostic tests that are specific for Typhoid fever are listed below.
Blood culture
For any infection, a blood test remains the primary confirmation. For Typhoid fever, a blood test is the first and most commonly preferred method of diagnosis.
The blood culture test is not very expensive and clinically reliable. The efficacy of blood culture increases when the blood sample is taken in high volume. The blood culture method of diagnosis is more reliable and may sometimes produce false negative results depending on the handling techniques.
ELISA
Enzyme Linked Immunosorbent Assay (ELISA) is used to detect the presence of specific antigens. These tests are helpful in identifying the carriers of the organism.
Fluorescent antibody
The fluorescent antibody test is a serological test for the diagnosis of Typhoid fever.
Platelet count
The platelet count is tested when a person is affected with Typhoid fever. The haematological changes that occur also indicate the presence of Typhoid fever.
Stool culture
Stool culture is also used to identify the presence of the species. Stool culture is usually used to detect the carriers of the infection. People affected by Typhoid can carry the infection for up to one year.
Widal test
Widal test is the usual method of testing for Typhoid fever. It detects the presence of antibodies against O-type and H-type antigens.
The antibody titer greater than 1:180 for anti-O and 1:160 for anti-H confirms the presence of Typhoid fever. The numbers are subject to change when it comes to endemic countries and geographic areas.
Widal test can sometimes produce false-negative and false-positive results. So, blood culture is required when the results are inconclusive.
Complications
Intestinal haemorrhage
Intestinal haemorrhage is bleeding in the gastrointestinal tract. It is a disorder that occurs in your digestive tract. The blood is usually seen in stools, and you may tend to vomit blood.
However, blood is not always visible. Internal haemorrhage can cause the stools to appear tarry or black. The bleeding can depend on the severity of the infection and symptoms. The internal haemorrhage can be a life-threatening condition.
Intestinal haemorrhage is a common complication of the infection, and with the adequate administration of medical care and antibiotics, the intestinal haemorrhage can be controlled.
Intestinal perforation
Intestinal perforation is a sudden loss of continuity in the intestinal bowel wall. The loss of continuity can lead to various complications.
Typhoid infection is one of the common causes of intestinal perforation. The other common causes of intestinal perforation include instrumentation, inflammation, malignancy, obstruction and ischemia.
When recognised early, the complication can be treated with a course of medication and might require surgery in rare cases.
Kidney failure
Another common complication caused due to Typhoid is kidney failure. People affected with acute renal diseases are more prone to kidney failure.
Peritonitis
Peritonitis is the inflammation of the peritoneum. The peritoneum is a membrane that lines the inner walls of the abdomen. The inflammation is usually caused due to bacterial infections like Typhoid.
Peritonitis usually requires immediate medical attention and can be cured with an antibiotic course. In rare cases, patients affected with peritonitis require surgery.
If symptoms of peritonitis are ignored, they can become a life threatening-medical condition.
Prevention of Typhoid
Salmonella infection can be prevented by following certain personal hygiene habits.
Wash your hands
Washing your hands frequently is very important and a primary personal hygiene habit. Before eating, wash your hands with soap and water. This will help to avoid pathogens getting inside our digestive tract.
Wash your hands with soap and water after using the toilets. These personal hygiene practices may help you avoid unwanted infections. If soap is not available, use an alcohol-based sanitiser.
Avoid drinking untreated water
Salmonella bacteria usually breed in contaminated and dirty water. Avoid drinking such water. Always drink clean and boiled water. This will help to kill the presence of any pathogens in the water.
Avoid raw fruits and vegetables
Do not consume raw fruits and vegetables. Clean the vegetables properly before consuming them.
The skin of the fruits and vegetables will have pathogens, and when consumed, they might cause infection.
Choose hot foods
Consume foods when hot, and after cooking the food, always make sure you cover the food. Flies and mosquitoes may carry infectious bacteria and can contaminate the food by sitting on them. So, it is always safe to eat foods that are cooked at the right temperature.
Keep a list of reachable doctors
Have an awareness of the medical condition and the medical facilities. Keep a list of the doctors and their addresses to contact them during emergencies.
When to see a doctor?
Consult your doctor when you have symptoms like headache, fever and abdominal pain.
If you have travelled to any country with an epidemic of Typhoid fever and you have any symptoms, consult your doctor.
Conclusion
Typhoid is an infection caused by bacteria, and the infection can be treated with the proper course of antibiotics. If left untreated, it can lead to a life-threatening condition.
Always consume foods that are covered and cooked properly. Do not consume foods that are raw, and drink only clean water. The bacteria breeds only in dirty water and contaminated environment.
Vaccination can also help to eradicate such infections. Also, be very watchful about your symptoms.
