Typhoid

Overview of typhoid

Pathogenic diseases are common in those parts of the world which are abundant in microbes. These regions, mainly the tropics and the sub-tropics are ideal for the birth and propagation of several pathogens. In the past, there have been cases where these diseases led to epidemics that took hundreds and thousands of lives. Typhoid is one such disease that arises from lack of immunization. In the year 2013, 11 million new cases of typhoid were reported worldwide (source: Global Burden of Disease Study, 2013). Nearly 1,61,000 of these cases resulted in death. The health organizations in the low and middle-income countries should spread awareness related to the disease in order to improve the current global scenario.

What is typhoid?

Typhoid, also known as Typhoid fever is a pathogenic disease mediated by the bacteria Salmonella typhi. It leads to fever, headaches and a wide range of gastrointestinal symptoms.

The disease is often accompanied by paratyphoid fever. Some of these patients develop skin rashes with rose-colored spots.

Diarrhoea and vomiting may occur in the advanced stages. Nearly 30-70% of the Typhoid cases can be avoided by means of proper vaccination.

What causes typhoid?

The primary causative agent of Typhoid is the bacterium Salmonella typhi. It mainly enters the body of the host through contaminated food and water. Poor sanitation and hygiene may exacerbate the existing conditions. It may also spread via direct contact with the flies and insects that sit on the fecal matter of the infected person. Unhygienic practices like having food without washing hands or cooking food with contaminated water may give rise to Typhoid. Two types of bacterium are responsible for spreading the disease- Salmonella typhi I and Salmonella typhi II.

What are the signs and symptoms of the disease?

The symptoms of Typhoid will be discussed in this section according to the number of weeks passed.

Week 1

The main symptoms observed in the first week are given below-

• Gradual increase in body temperature
• Temperature may fluctuate frequently
• Slow heart rate
• Headache
• Cough (productive or non-productive)
• Nose-bleeds (epistaxis)

A reduction in the number of white blood cells (WBC) occurs, leading to Leukopenia. The eosinophil count also dips and gives rise to eosinopenia. Lymphocytosis is also observed in a few cases that are characterized by an abnormal increase in the number of lymphocytes in the blood.

Week 2

• Persistent weakness (the person cannot get up from the bed)
• High fever (104^o F) that rises mainly in the afternoon
• Slow heart rate
• Delirium (leads to “nervous fever”)
• Appearance of pinkish spots on the lower chest and abdomen
• Generation of coarse respiratory sounds (Rhonchi)
• Abdominal distension
• Pain in the right lower quadrant of the abdomen
• Rumbling noise from the stomach (Borborygmi)
• Diarrhoea, characterized by greenish, smelly stools
• Enlargement of the liver and the spleen (hepatosplenomegaly)

Week 3

• Intestinal hemorrhage (due to bleeding in the accumulated Peyer’s patches)
• Perforations in the distal ileum
• Sepsis or Septicaemia
• Encephalitis (brain inflammation)
• Respiratory ailments (Pneumonia or bronchitis)
• Delirium or coma vigil
• Abscesses that spread to the other parts of the body
• Hepatic symptoms
• Inflammation of the inner layers of the heart (endocarditis)
• Bone inflammation (Osteitis)
• Acute dehydration
• Appearance of macular rashes on the trunk
• Reduction in platelet count

The fever starts remitting by the end of the third week. This marks the beginning of the recovery stage.

What are the important diagnostic tests for typhoid?

Typhoid detected in the early stages is easier to cure. The following diagnostic tests can help detect the disease-

• Blood test
• Bone marrow culture
• Stool culture

Two other crucial tests are-

• Widal test: It is usually a time-consuming test that yields positive results only in the second and third weeks of the disease. The test is mostly positive in the second-week antiO and antiH antibodies. The blood culture tests might not yield some significant results at this stage.
• Typhidot test: It encompasses a dot ELISA kit that detects the IgM and the IgG antibodies against the outer membrane protein (OMP) of the Salmonella typhi. This test yields positive results within 2-3 days of infection. This enables the separate identification of the IgG and the IgM antibodies. IgG results show remote infection, while IgM shows recent infection.

What treatments are available?

The diarrhoeal symptoms of typhoid can be treated with oral rehydration therapy. In general, a third-generation cephalosporin such as ceftriaxone or cefotaxime is a first choice of the doctors while treating typhoid. Fluoroquinolone medications such as ciprofloxacin are recommended in the cases where resistance is uncommon. The fever is generally treated with certain antibiotics such as amoxicillin, ampicillin, chloramphenicol, and ciprofloxacin.

Surgical intervention is carried out in case of intestinal perforations.

In a majority of the cases, a surgical closure of the perforations is done with drainage of the peritoneum.

For the patients with multiple perforations, small bowel resection is generally recommended.

Immunocompromised people are more likely to suffer from typhoid.

Two types of Typhoid vaccines namely the live, oral Ty21a vaccine and the Typhoid Polysaccharide Vaccine need to be administered in the childhood in order to eliminate chances of Typhoid in future.

For the oral vaccine, booster doses are recommended every 5 years and for the injectable form, these doses are necessary after every 2 years. This would reduce risks of the disease by about 30-70%. Sufficient funds should be allotted to the health organizations in the low and the middle-income countries so that children of the underprivileged families also receive the necessary immunizations. This will help reduce the global burden of Typhoid and other communicable diseases to a considerable extent.

Treatment & Prevention

Since typhoid is a bacterial infection, it is mainly treated through antibiotics such as ciprofloxacin or ceftriaxone. The patient should drink enough fluids to avoid dehydration. Before travelling to a typhoid-prone region, it is important to get vaccinated for this disease. It is important to note that vaccines are not a 100% effective; hence one should maintain proper hygiene and avoid consumption of contaminated food or water. Always drink boiled or bottled water while travelling. Refrain from consuming food that has not been handled hygienically such as street food. If suffering from typhoid, refrain from consuming raw fruits and vegetables. Vaccination among high-risk population can help prevent typhoid at a larger scale.

Typhoid home remedies

The antibiotics prescribed for typhoid are effective in treating the condition however by including these following home remedies you can speed up the recovery process:

• Boil 5-6 cloves in water. Cool this mixture and drink 2-3 times a day. Clove has strong anti-bacterial properties. It helps in flushing out the toxins from the body and also aids in reducing the frequency of vomiting during typhoid.
• Drinking buttermilk 2-3 times a day can also be effective. This soothes the gastrointestinal tract and restores electrolytic balance in the body.
• Make a mixture of lemon and honey with warm water and consume from time to time. This reduces bodily inflammation and naturally heals the digestive tract.
• In case of high fever, soak a clean piece of cloth in 2 parts water mixed with 1 part apple cider vinegar and keep this on the patient’s forehead and abdomen. It is an effective measure in reducing the fever symptoms.

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