What is typhoid fever?

Typhoid fever, otherwise known as enteric fever, is a bacterial infection caused by Salmonella typhi (S. typhi). It is transmitted through food or water contaminated with infectious faeces, causing severe diarrhoea and a rash. It is more common in developing countries, in areas of poor sanitation.

Causes

Typhoid fever is caused by Salmonella typhi bacteria. They enter the body when contaminated food or water is ingested. They then travel to the bloodstream where they spread throughout the body. Sometimes the bacteria manage to enter the gall bladder, in which case people become carriers. Carriers do not have symptoms, but they continue to expel the bacteria in their faeces, which can then infect others if water and food supplies become contaminated.

Gall bladder

A small organ attached to the liver that stores bile until it is released into the small intestine, to aid the digestion of food.

Risk factors

Risk factors for typhoid fever include:

  • Travel to developing countries with poor sanitation;
  • Ingesting raw and undercooked food, or untreated water that may be contaminated with S. typhi;
  • Not being vaccinated against S. typhi, and;
  • Poor personal hygiene.

Signs and symptoms

In the early stages of infection, possible symptoms include:

  • Diarrhoea;
  • Fever;
  • Abdominal pain, and;
  • A rash of small red spots on the abdomen and chest.

Other potential symptoms include:

  • Abdominal discomfort;
  • Bloody stools;
  • Chills;
  • Confusion;
  • Weakness and fatigue, and;
  • Nosebleeds.

Typhoid fever causes a red rash on the abdomen and chest.Typhoid fever can cause a rash of red spots on the abdomen and chest. 

Methods for diagnosis

A doctor may suspect typhoid fever based on your signs and symptoms. To confirm the diagnosis, blood, urine and stool samples are also tested for the presence of S. typhi bacteria.

Types of treatment

Typhoid fever may initially be treated in a hospital, particularly if you have severe symptoms. Types of treatments include:

Intravenous fluids

You can quickly become dehydrated as a result of diarrhoea. Replacing fluids helps to maintain your hydration and electrolyte levels.

Antibiotics

Antibiotics, such as ciprofloxacin and ceftriaxone, may be used to clear the infection. With rising rates of antibiotic resistance, more broad-spectrum antibiotics are required to successfully treat the infection.

Self care

You will generally be discharged from the hospital once you are improving. It is likely that you will be given oral antibiotics to continue at home. In addition, the following is recommended:

  • Regular washing of your hands with soap, especially after visiting the toilet, to prevent infecting others or re-infecting yourself;
  • Keep well hydrated, preferably with water and oral rehydration drinks;
  • Avoid spicy or greasy foods and try to eat mainly bland foods, such as dry crackers, until your symptoms settle, and;
  • Unless prescribed by your doctor, avoid taking anti-diarrhoea or anti-nausea medications, which can prolong infections and delay recovery.

Electrolyte

Substances that form ions when dissolved in water. These include potassium and sodium minerals that are necessary for normal functioning of the body and all its cells.

Potential complications

Intestinal haemorrhage and perforation

The most common complication of typhoid fever is bleeding in the gastrointestinal tract (intestinal haemorrhage), as the infection damages the lining of the intestine. This can show up as bloody faeces.

Other complications that can occur as a result of severe dehydration, or bacteria spreading throughout body, include:

  • Kidney failure (although this is a rare complication);
  • Inflammation of the abdominal wall lining;
  • Inflammation of the heart muscle, and;
  • Inflammation of the lung/s.

Gastrointestinal tract

The membrane-lined series of organs extending from the mouth to the anus through which food passes during digestion.

Prognosis

Symptoms of typhoid fever usually subside within 2-4 weeks of starting a treatment. If the infection is treated early, the prognosis is good but, left untreated, the prognosis can be poor due to development of the serious complications described earlier. Symptoms may also return after treatment if the infection has not been completely cleared from the body.

Prevention

You can reduce your risk of developing typhoid fever by being vaccinated with a typhoid vaccine before your trip and by avoiding untreated water and raw foods that may have been exposed to untreated water supplies. Even with a vaccination, care should be taken with following food safety while travelling as a vaccine may not provide full protection to all people.

Vaccine

A preparation containing a microorganism (that causes a specific disease) in a dead or weakened state, or parts of it, for the purpose of inducing immunity in a person to that microorganism.