Typhoid fever is a bacterial infection that has the potential to spread throughout the body, affecting multiple organs. It can result in serious complications and even prove fatal if not treated right away.

This condition is caused by the bacterium Salmonella typhi, which is related to the bacteria that causes salmonella food poisoning.

Typhoid fever is a highly contagious disease. Infected people can pass the bacteria in their feces or, less commonly, in their urine. When another person consumes food or water contaminated with even a trace of infected feces or urine, they can become infected with the bacteria and develop typhoid fever.

Typhoid fever is most common in areas with poor sanitation and limited access to clean water.

Globally, it is believed that children face the highest risk of contracting typhoid fever, likely due to their developing immune systems, which are the body's natural defense mechanisms against infection and illness.

Interestingly, children afflicted by typhoid fever generally experience milder symptoms compared to adults.

The Underlying Causes of Typhoid Fever

Typhoid fever, caused by Salmonella enterica serotype Typhi, is a bacterial disease, while paratyphoid fever is caused by other Salmonella strains.

These bacteria are most commonly found in areas where outbreaks are common. They are excreted from the body in infected people's feces and urine. These bacteria can spread from hands to surfaces or other people if proper hand hygiene is not practiced after using the restroom.

Bacteria can spread directly from one person to another and can contaminate uncooked foods like raw fruits. In areas without treated water, bacteria can be acquired through untreated water, ice, or unpasteurized milk or juice, despite the lack of proper treatment.

Detecting Typhoid and Identifying Common Symptoms

Typhoid symptoms typically appear within a range of six to thirty days after exposure to the pathogen. The primary symptoms include typhoid fever and a rash.

Typhoid fever is a highly severe condition, marked by a gradual rise in temperatures to as high as 104 degrees Fahrenheit (39 to 40 degrees Celsius) over several days.

Although not always present, the accompanying rash is distinguished by rose-colored patches that primarily appear on the neck and abdomen.

The most common typhoid symptoms are:

• Headache
• Chills
• Appetite loss
• Stomach pain
• Rashes
• Cough
• Muscle aches
• Nausea
• Diarrhea

Frequently, individuals can harbor the bacteria without displaying any noticeable symptoms. Symptoms tend to emerge gradually and typically become apparent after a period of 1-3 weeks. In some cases, people can carry the bacteria without being affected, becoming asymptomatic carriers who show no signs or symptoms of the illness.

How Typhoid Infections Occur

Typhoid infections primarily occur through the ingestion of food or water contaminated with the bacterium Salmonella enterica serotype Typhi. The bacteria are shed in the stool and, less commonly, in the urine of infected individuals, facilitating their transmission to the environment. Poor sanitation and limited access to clean water in certain regions contribute to the prevalence of typhoid outbreaks.

Inadequate hand hygiene following restroom use can transfer bacteria from contaminated hands to surfaces, objects, or other people. Furthermore, person-to-person transmission can occur, particularly in close-contact settings. Consumption of raw or uncooked foods, such as unpeeled fruits, can introduce bacteria into the digestive system. Contaminated water sources, such as drinking water, ice made from untreated water, and unpasteurized beverages, can serve as vehicles for typhoid infection in areas where water is not effectively treated to eliminate germs.

Typhoid Fever and Its Impact on the Body

In addition to severe vomiting, diarrhea, and abdominal bloating, an individual afflicted with severe typhoid fever may also encounter the following detrimental effects on their body. Immediate hospitalization is imperative in such cases.

● GI bleeding and ulcers

● Lung complications

● Sepsis

● Meningitis

● Typhoid Encephalopathy

●     Myocarditis or Pericarditis

How to Fight Typhoid Infections?

The sole effective typhoid treatment is antibiotic

The choice of antibiotics prescribed for typhoid treatment may vary depending on the source of the bacterial infection. Different strains of the bacterium may exhibit varying degrees of susceptibility to specific antibiotics. These medications can be administered individually or in combination. Some of the antibiotics commonly used for the treatment of typhoid fever include:

● Fluoroquinolones, such as ciprofloxacin (Cipro), are often considered a primary choice for treatment. They inhibit bacterial replication, although certain bacterial strains can exhibit resistance to these antibiotics.

● Cephalosporins, a class of antibiotics that hinder the formation of bacterial cell walls, are another option. Ceftriaxone, in particular, is employed in cases of antibiotic resistance.

● Macrolides, another group of antibiotics, function by impeding protein synthesis in bacteria. Azithromycin (Zithromax), a type of macrolide, can be utilized in instances of antibiotic resistance.

● Carbapenems, yet another class of antibiotics, also prevent bacterial cell wall formation but target a different stage of this process compared to cephalosporins. These antibiotics are reserved for severe cases of the disease that do not respond to other antibiotic treatments.

● Staying hydrated by drinking fluids is crucial to prevent dehydration, which can result from prolonged fever and diarrhea. In severe cases of dehydration, intravenous fluid administration may be necessary.

●     In situations where the intestines sustain damage, surgical intervention may be required to repair and address the issue.

Challenges in Typhoid Treatment

With the emergence of promising new vaccines for the management of typhoid fever, members of the CaT initiative are actively addressing various challenges that could hinder their widespread adoption. These challenges encompass, but are not restricted to:

● In the absence of comprehensive data on the impact of typhoid fever and the potential benefits of a vaccine, the decision-makers responsible for global immunization policy and funding lack the necessary information to make informed choices regarding vaccine support.

● For effective vaccine deployment, it is imperative to develop well-crafted strategies specifying who should be vaccinated, where, and how. These strategies must be underpinned by robust evidence, a critical component of the policymaking process at global, regional, and national levels. Often, mathematical modeling is employed to analyze and refine these strategies.

● While typhoid vaccines are most urgently needed in developing countries where the disease is endemic, these nations often face challenges in affording the prices set by vaccine manufacturers. Donor financing plays a pivotal role in ensuring affordable vaccine pricing and is indispensable for integrating new vaccines into national immunization programs.

●     The delayed and inaccurate diagnosis and treatment of typhoid fever result in escalated costs, increased rates of severe complications, and a higher incidence of fatalities. In many regions, the disease is frequently misdiagnosed as other illnesses like malaria, dengue, or pneumonia due to its non-specific clinical symptoms. This misdiagnosis hampers efforts to gather reliable data on disease burden and identify high-risk groups effectively.

Preventing Typhoid Fever Through Vaccination and Hygiene Practice

Currently, there are two vaccines available for typhoid fever. However, these vaccines do not provide lifelong immunity, necessitating additional doses to maintain protection. While they significantly reduce the risk of contracting typhoid, they do not offer an absolute guarantee against the disease. It's worth noting that these vaccines might also offer some degree of protection against paratyphoid fever, although this aspect hasn't been extensively tested.

● Oral Vaccine: The oral typhoid vaccine consists of four pills taken every other day. However, it's worth noting that as of December 2020, this vaccine is no longer available from the manufacturer.

●     Injectable Vaccine (Shot): The injectable typhoid vaccine is administered as a single shot. To ensure your body has sufficient time to develop defenses (antibodies), it's recommended to receive this vaccine at least two weeks before traveling to an area where typhoid is prevalent. Children aged 2 and older are eligible for the typhoid shot, and to maintain protection, a booster shot should be administered every two years.

Hygiene Practices

● Handwashing: Regularly wash your hands with soap and clean water for at least 20 seconds, especially before eating, after using the toilet, and after handling raw food.

● Safe Water: Consume only purified or boiled water. Avoid drinking tap water or using it to brush your teeth.

● Food Safety: Eat only thoroughly cooked and hot foods. Avoid raw or undercooked eggs, meat, and seafood. Be cautious with street food.

● Fruit and Vegetable Handling: Wash fruits and vegetables thoroughly with clean water before consumption, especially if you're eating them raw.

● Personal Hygiene: Maintain good personal hygiene. Keep your fingernails short and clean. Avoid sharing personal items like towels and utensils.

● Sanitation: Use clean and well-maintained toilets. Ensure proper disposal of sewage and waste.

● Avoid Contamination: Be cautious with close contact with someone who has typhoid. Avoid sharing food or drinks with them.

●     Travel Precautions: If traveling to an area with a high risk of typhoid, follow travel advisories and take necessary precautions, including vaccination and careful food and water choices.

Although typhoid fever may appear to be a historical ailment, it still poses a significant threat to people worldwide. If you reside in or plan to visit regions where typhoid is prevalent, vaccination remains the most effective means of preventing illness and limiting the spread of the disease.

FAQs

1. What causes typhoid fever?

- Typhoid fever is caused by the bacterium Salmonella Typhi. It spreads through contaminated food, water, or close contact with an infected person's feces.

2. What are the common symptoms of typhoid fever?

- The typical symptoms include a high fever, weakness, abdominal pain, headache, and a rose-colored rash. Diarrhea and constipation may also occur.

3. How is typhoid fever diagnosed?

- Diagnosis is usually based on blood, stool, or urine tests to detect the presence of Salmonella Typhi. Your doctor may also consider your symptoms and medical history.

4. What is the treatment for typhoid fever?

- Typhoid fever is treatable with antibiotics. Commonly prescribed antibiotics include ciprofloxacin and ceftriaxone. Adequate rest and fluid intake are also important for recovery.

5. How can typhoid fever be prevented?

- Prevention involves practicing good hygiene, including handwashing, drinking purified water, and consuming safe, well-cooked food. Vaccination is available and recommended for travelers to high-risk areas.