Typhoid (also known as enteric fever) is a common, worldwide severe, infectious and life-threatening disease caused by contaminated foodstuff, drinks and water by bacteria known as Salmonella typhi, which may cause fever with severe complications. Close contact with infected people may also cause this disease. The bacterium Salmonella typhi is transmitted through the fecal oral route. Typhoid can also be caused by Salmonella paratyphi, a related bacterium that generally leads to a less severe illness. It is more common in Tropics.
The bacteria are first deposited in water or food by a human carrier and are then spread to other people in the vicinity.
Typhoid fever occurs worldwide. Even though it is very rare in the developed world it is still a real threat to the developing nations whose sanitary conditions are poor. Typhoid fever is prevalent in Asia, Africa, Latin America, the Caribbean, and Oceania, but 80% of cases are reported to come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam. Within these countries, typhoid fever is widespread in underdeveloped areas. Typhoid infects around 21.6 million people (incidence of 3.6 per 1,000 populations) and an estimated 200,000 people die every year.
In the United States, most cases of typhoid fever are evident in international travelers. The average yearly occurrence of typhoid fever per million travelers from 1999-2006 by county or region of departure was as follows:
- Canada – 0
- Western Hemisphere outside Canada/United States – 1.3
- Africa – 7.6
- Asia – 10.5
- India – 89 (122 in 2006)
- Total (for all countries except Canada/United States) – 2.2
Prompt and suitable antibiotic therapy is useful to make typhoid fever normally a short-term febrile disease that requires a median of 6 days of hospitalization. While treated, it has few long-term sequels and a 0.2% risk of mortality where as untreated typhoid fever is a fatal illness of several weeks’ duration with long-term morbidity. It often involves the central nervous system. The rate of casualty in the United States in the pre-antibiotic era was 9%-13%.
How is it Transmitted
Typhoid fever can be transmitted in several ways:
The bacteria are spread by typhoid patients and carriers in considerable amount through stools and vomit.
The bacteria then contaminate foodstuff, drinks and water through house-flies and other insects. These contaminated food or drinks, when consumed results in typhoid.
Raw vegetables cultivated on sewage-irrigated fields also act as a medium of infection.
The bacteria can survive in soil and water for several months.
Bacteria spread fast in milk and milk-products.
Stage wise symptoms
Later stageConstant high fever
Variable degrees of unconsciousness
|Initial stage||High fever
A carrier is usually Salmonella typhi infected person, who may transmit disease to others, as the bacteria remain in the body for several months. 3-5% of typhoid patients remain chronic carriers in spite of treatment. Typhoid fever is spread by the intake of the bacteria through contaminated food or water. Patients with severe illness can contaminate the neighboring water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, consequently, contaminate the food supply. About 3%-5% of patients become carriers of the bacteria after a recovery from the acute typhoid. Some patients experience a very mild illness that goes undiagnosed. These patients can easily become long-term carriers of the said bacteria. The bacteria gather in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can stay alive for weeks in water or dried sewage. These chronic carriers may show no symptoms and can be the source of new outbreaks of typhoid fever for many years.
Most common complications include intestinal bleeding and perforation.
Typhoid fever is best treated with antibiotics like ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin that destroy the Salmonella bacteria. Before the use of antibiotics, the fatality rate was 20%. Death then generally occurred from great infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, death rate has been reduced to 1%-2%. With proper antibiotic therapy, you can mark improvement within one to two days and recovery within 7 to 10 days.
Complete bed rest is crucial.
Patient should be kept on a liquid diet of orange, barley juice and milk.
Orange juice especially accelerates recovery increasing energy, urinary output, and promoting body resistance.
Sanitation and hygiene are the serious measures that should be taken to prevent typhoid.
Measures to be taken:
- Clean hygienic habits
- Drinking only purified water
- Abstaining from eating raw leafy vegetables
- Avoid food left opened.
Vaccination is also essential to prevent the disease. A single injection given 2 years onwards provides protection against typhoid for 3 years.