Enteric (typhoid) fever

Dr. Faozat Aragbaye
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Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi.

It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. Approximately 3%=5% become carriers of the bacteria after the acute illness. An estimated 11-20 million people get sick from typhoid and between 128,000 and 161,000 people die from it every year.

Causes

Typhoid is caused by the bacteria Salmonella typhi and spread through food, drinks and drinking water that are contaminated with infected faecal matter. Washing fruits and vegetables can spread it, if contaminated water is used. No animals carry the disease, so transmission is always human to human.

 Signs and symptoms

The incubation period is usually one to two weeks, and the duration of the illness is about four to six weeks

The two major symptoms of typhoid are prolonged high fever and rash. Fever is particularly high, gradually increasing over several days up to 39 to 40 degrees Celsus.

Other symptoms can include:

• weakness
• abdominal pain and peritonitis
• constipation or diarrhoea
• headaches
• nausea and vomiting
• poor appetite
• lethargy ( usually only if untreated)
• generalized aches and pains
• intestinal bleeding or perforation ( after two to three weeks of the disease)

Rarely symptoms might include confusion, diarrhea, and vomiting, but this is not normally severe. In serious untreated cases the bowel might become perforated.

Diagnosis

A diagnosis of typhoid fever can usually be confirmed by analysing samples of blood, stool or urine. These will be examined under a microscope for Salmonella typhi bacteria.

Treatment

Several antibiotics are effective for the treatment of enteric fever. The choice of antibiotics is guided by identifying the geographic region where the infection was contracted and if relapses occur, patients are retreated with antibiotics. Those who become chronically ill can be treated with prolonged antibiotics. Often, removal of gallbladder, the site of chronic infection, will provide a cure.

Other than antibiotics, it is important to rehydrate the patients by drinking adequate water or intravenous fluids. In most severe cases, where the bowel is perforated, surgery may be required.

Complications

About 1 in 10 people experience complications, which usually develop during the third week of infection. The two most common complications in untreated typhoid fever are:

• Internal bleeding
• Splitting (perforation) of a section of the digestive system or bowel, which spread the infection to nearby tissue and Prevention.

Countries with less assess to clean water and washing facilities typically have higher number of typhoid cases. Vaccination is however, recommended for people travelling to a high risk area. For travellers the following precautions should be taken:

• Vaccines are not 100 percent effective and caution should be exercised when eating and drinking. The current vaccines are not always effective.
• Eat foods that have been thoroughly cooked.
• Avoid raw vegetables and fruits that cannot be peeled.
• Peel raw fruits and vegetable yourself if you must eat them.
• Avoid foods and beverages from street vendors.

Avoid raw milk and its products. Drink only pasteurized or boiled milk.