What is typhoid? What do you know about causes, symptoms, treatment, prevention and history of typhoid?

Typhoid, a serious intestinal infection, is most often caused by ingesting contaminated food or water. According to the Centers for Disease Control and Prevention, around 4,000 Americans get the infection each year, and at least 380 people die from it.

Typhoid fever is caused by Salmonella typhi bacteria, which can infect the intestines and bloodstream. Other symptoms include fever, stomach pain, nausea and vomiting.

It typically clears up within a week, but untreated it can be fatal.

The disease is rare in the UK and occurs most often in the developing world and among migrants to the UK.

The symptoms are often vague, with infected people not showing any signs until their salmonella has taken hold.

Symptoms usually appear between a day and a week after exposure to Salmonella typhi bacteria.

Anyone can carry the bacteria, but in most cases, it is not serious and clears up without treatment.

However, in some cases, the infection can be serious.

Typhoid is particularly a concern in overcrowded areas, where the disease can spread quickly.

Mortality

The mortality rate of typhoid is approximately 5%. The commonest causes of death are heart attack and infection of the major blood vessels of the body.

What are the symptoms?

Typhoid fever can cause a wide range of symptoms, ranging from just mild tummy ache to serious illness and even death.

Some of the most common signs include:

Fatigue

A high fever

Stomach pain

Vomiting

Nausea

Confusion

Diarrhoea

Headache

Skin rash

Often the symptoms don’t show up for a few days and if you have never eaten or drunk anything affected by the disease before, you may not even realise you’ve caught it.

Typhoid only affects people with impaired immunity, which includes:

those with HIV/AIDS, diabetes, cirrhosis, liver disease, kidney disease or due to drug or alcohol abuse

people who have not been vaccinated or have not received a live vaccine (i.e. the Typhoid vaccine) within 14 days of infection

those who receive post-transplant chemotherapy or have received medication that can weaken their immune systems

those with weakened immune systems due to an illness, surgery or substance abuse

Causes of typhoid

Typically, typhoid is caused by ingesting food and water contaminated with the bacterium Salmonella typhi (or S. Typhi). It can also be caused by contaminated medical equipment, such as needles, syringes, or dental equipment. People infected with S. typhi excrete a toxin that irritates the esophagus and lungs.

If food or drink is left out, then it can become contaminated. This is particularly a problem for people with compromised immune systems and young children.

Is there an antibiotic treatment for typhoid?

There is no antibiotic treatment for typhoid fever, and once symptoms appear, it is essential to get treatment straight away.

Diarrhoea, vomiting and fever can be treated with oral rehydration salts (ORS).

However, about 10 percent of people who are infected with typhoid do not get better after this treatment, and will need hospital treatment.

If your symptoms do not improve in a few days, or you have a high temperature of 38C or more, you should call emergency help line or go to your local Accident and Emergency (A&E) department.

What tests can you have for typhoid?

You can have a simple blood test to check if you have typhoid.

More detailed tests, such as a stool sample, can also diagnose the infection.

Typhoid is very rare in the UK and can be spread by contaminated food and water, or by the faecal-borne Salmonella typhimurium bacterium.

However, it can be difficult to protect against the disease, and there are many different ways to spread the infection.

Prevention from typhoid

Typhoid is more commonly found in developing countries. To reduce the risk of contracting the disease, the World Health Organization (WHO) recommends that people wash hands thoroughly after coming in contact with any surface or object that may have become contaminated. People should also always follow these simple hygiene precautions:

Don't eat or drink food or water from an unknown source.

Keep food in a clean container.

Cook food thoroughly to ensure all the germs are killed.

Only drink water from safe sources.

Avoid swallowing water while washing your hands.

Practice good hygiene to stop the spread of typhoid:

Wash hands with soap and water.

Wash cooked and uncooked fruits and vegetables with tap water.

Adopt the habit of washing your hands prior to preparing or eating meal.

Do not prepare food and drinks in the same bowl or plate.

Do not use the same cutlery as other people.

The safest way to drink water is to boil it first.

Treatment of typhoid

Anti-typhoid drugs include chloroquine, sulfadimethoxine (50 mg or 500 mg depending on the amount of typhoid exposure), sulfasalazine (0.5–2 g per day), and meropenem (0.5 g). Some have recommended atropine in the form of spray; however, this has not been shown to be effective.

Antibiotics have also been used, such as ceftiofur. Antibiotics may be given for only 6 to 8 days at a maximum of 5 mg per day; otherwise, patients are recommended to take medications indefinitely. This decision is made on the basis of a patient's blood level of histamine, based on evidence from case studies. This varies from person to person.

However, it may be an issue that different strains of the same typhoid fever can trigger fever in different patients, and antibiotics may increase the risk of the infection for the individual. Antibiotics can also inhibit drug-resistant organisms.

The use of oral rehydration salts is recommended as part of the treatment. It is necessary to replace lost fluids. Tetracycline has been shown to be very useful in the treatment of typhoid fever in a dose of 2.5 to 4 g. This is followed by 2 g or less in every 24 hours for 14 days.

The tetracycline is best administered as an injection into a vein. A combination of ceftriaxone and didanosine is used to treat typhoid fever, but this is not recommended in the United Kingdom due to the risk of resistance.

Trials of several new antibiotics, including cefotaxime, meropenem, and ceftazidime, are being investigated for treatment of typhoid fever. A related disease, giardiasis, is treated similarly to typhoid fever.

Treatment of typhoid fever in hospitalized patients is recommended to include administration of vancomycin, an antibiotic, intravenous fluids to replace lost fluids, and blood transfusions when the blood coagulation and clotting are impaired.

History

Typhoid fever was first identified in Japan in 1901 by Yoshimi Kaihara in Shimonoseki, Japan. In 1924, it was identified in New Zealand by Taro Takahashi. In 1948, several cases were found in Kenya. In 1949, another outbreak was seen in the United States. In 1952, the first outbreak in Europe was identified in the United Kingdom.

There were other sporadic outbreaks in Europe and the United States until the mid-1960s. In the 1960s, European countries began introducing new sanitation and water supply infrastructure which resulted in decreased occurrence of the disease. Since the late 1960s, typhoid has been rare in developed countries.

In Africa, high incidence of typhoid is found in parts of southern Africa. In Nigeria, the first case of this strain of typhoid fever was identified in 1948 and, since that time, the incidence has steadily increased. It is estimated that 13,000 Nigerians are infected each year. The main risk factors are unhygienic living conditions, poor housing and sanitation, and poor water treatment and supply.