TYPHOID FEVER – Symptoms, Causes, Diagnosis, and Treatment

Typhoid fever is a very common fever associated with gastrointestinal symptoms. Poor hygiene sanitation and impure water is the key point for this infectious disease. Typhoid fever is a type of enteric fever, It is very much prevalent in our India and mainly caused by a bacteria Salmonella Typhi. Typhoid can also be caused by Salmonella Paratyphi (especially subtype A). The bacteria after entering into the gastrointestinal tract invades mucosa then replicated in Peyer’s patches of the intestine.

SIGNS AND SYMPTOMS –

  • High-grade fever
  • Headache
  • Bodyache
  • Malaise
  • Arthralgia
  • Sweating
  • Anorexia or loss of appetite
  • Constipation in early stages, later pea soup diarrhea
  • Nausea and vomiting
  • Cough
  • Sore throat
  • Typical rash ( rose spot) in the second week of fever.
  • Relative Bradycardia ( Faget sign) In spite of fever pulse rate is low.
  • Later signs are spleenomegaly (enlarge spleen) and abdominal distension.
  • Epistaxis (bleeding from the nose)

COMPLICATION

The complication of Typhoid fever includes gastrointestinal bleeding and intestinal perforation. Rarest complications are meningitis, neuritis, Guillain Barre syndrome, pancreatitis.

INVESTIGATION

  • Serological test – Typhoid fever is the best diagnosis by blood culture. It is highly sensitive.
  • Widal test – Serial rise of widal titer is used for diagnosis of enteric fever.
  • Typhidot test – It is also a sensitive test. Here ELISA kit detects IGM and IgG antibodies against OMP ( Outer Membrane Protein).
  • Leucopenia or low WBC count is often found in typhoid fever.
  • Bone marrow culture and stool culture is also used for typhoid detection.  

PREVENTION

Proper hygiene and sanitation is the key point for typhoid fever prevention. Drink pure water to avoid bacteria-contaminated water. Protect your food carefully to avoid contamination. Proper handwashing must be done before food intake. The typhoid vaccine is advised for people traveling to typhoid endemic areas.

VACCINE – Typhoid vaccine doesn’t provide absolute protection against Salmonella Typhi. Typhoid vaccine is of 2 types –

  • Live vaccine – Oral Ty21a is a live attenuated vaccine. Dose schedule – Dose day 1, day 3, day 5, day 7. Live Vaccine is available in capsule form. Each capsule is ideally taken 1 hour before a meal. It gives up to 5 years of protection and must be given above 6-year-old children. Re vaccination is necessary for every 5 years with a full four doses.
  • Killed Vaccine – Killed vaccine (Vi CPS) is the injectable vaccine, gives protection for up to 2 years. It is given as a single dose intramuscular vaccine and must be given above 2 years old. It contains purified Vi capsular polysaccharide.

TREATMENT

As Typhoid fever is a bacterial infection, it is treated by using proper antibiotics. Uncomplicated enteric fever is usually treated at home with proper antibiotics and antipyretics. In the case of oral antibiotics, resistant or enteric fever associated with complications like vomiting, diarrhea or abdominal distension should be hospitalized for better management.

Most commonly used antibiotics are –

  1. FluoroquinolonesCiprofloxacin or Levofloxacin are widely used to treat Salmonella typhi infection.
  2. Macrolides – Azithromycin is highly effective against typhoid fever. Azithromycin 1g per day orally given.
  3. Cephalosporin – Third-generation cephalosporin is highly sensitive to Typhoid. Injection ceftriaxone 2gm IV per day usually given. Oral cefixime 400mg per day is an alternative.

Some typhoid patients may become a chronic carrier, they should be monitored carefully and treated accordingly.

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