Typhoid fever is bacterial condition caused by Salmonella typhi. Salmonella typhi is a gram negative bacterium that lives in the intestines and bloodstream of human. It is gotten through ingestion of contaminated food and water. Animal don’t carry this disease, so transmission is always human to human. It is an acute illness characterized by fever, constipation/ diarrhea, headache, loss of appetite. Without treatment the disease can be fatal.

According to WHO, about 21 million cases of typhoid fever and 222,000 typhoid-related deaths occur annually worldwide. It is a common infection especially in low income countries where poor sanitation, hygiene and water supply.

Symptoms

This is usually noticed 6-30days after ingestion of the bacteria through infested food or water.

The initial symptoms noticed are;

  • Low grade fever
  • Headache
  • Abdominal pain
  • Constipation
  • Loss of appetite

In the second week of infection the person presents with;

  • Weakness
  • High grade fever
  • Rose spots (commonly seen in light people)
  • Diarrhea

In the third week the following symptoms can be also noticed

  • Intestinal perforation due to erosion of the lymphatic patches in the intestine. It can be very fatal if not promptly treated.
  • Peritonitis which is the inflammation of the covering of the abdomen and is a complication of intestinal perforation.
  • Psychiatric manifestations such as delirium which is an acutely disturbed state of mind characterized by restlessness, illusions and incoherence.
  • Dehydration

Diagnosis

Diagnosis is usually confirmed with a bone marrow, blood or stool cultures.

A full blood count reveals leukopenia with relative lymphocytosis

Widal test which was initially used in the diagnosis of typhoid fever has been abandoned because it is time-consuming, and prone to significant false positive results. The test may be also falsely negative in the early course of illness. Also it can be positive after a single test in people with malaria, previous exposure to salmonella or typhoid fever vaccination.

Treatment

Typhoid fever is treated through the use of antibiotics.

Supportive care is also very important such as rehydration, mediction to control fever and to reduce pain.

Surgery is indicated in cases of intestinal perforation.

There can be a carrier state in people with typhoid fever whereby the salmonella organism is cleared from the blood stream but is stored in the gall bladder and can be excreted in stool. These people are the source of continuous infection of people.

Without effective treatment,typhoid fever has a case fatality rate of 10-30%.

Prevention

  • Ensure the food you eat is cooked and served hot, don’t eat food at room temperature.
  • Eat hard cooked eggs as raw or soft boiled eggs can be a source of salmonella bacteria
  • Take only pasteurized diary milk and milk products. Unpasteurized milk can be a breeding ground for the bacteria
  • Avoid raw or undercooked (rare) meat or fish
  • Wash your fruits and vegetables properly before eating
  • Always wash your hands after the use of toilet and before you eat.
  • Provision of good drinking water supply
  • Be careful with food from street vendors
  • Drink only clean, sterilized or boiled water.
  • Vaccination; typhoid vaccine can be collected especially by people travelling to endemic areas. Typhoid fever is not 100% protective but it reduces the severity of the disease.
  • Routine screening and treatment of food vendors/handlers