Typhoid fever – symptoms, vaccination

Proven content

Typhoid fever is an acute infectious disease caused by the typhoid fever (Salmonella typhi). It is sensitive to disinfectants, sunlight and heat, and it also produces endotoxin responsible for most disease symptoms. The range of the incidence of typhoid fever covers the whole world, but the incidence of typhoid fever in developed countries is small, while in countries with low sanitary-epidemiological status, typhoid fever is endemic.

Typhoid fever – definition

Typhoid fever is an infectious disease of the gastrointestinal tract, caused by Salmonella typhi bacteria. It is a gram negative bacterium. Only humans (carriers or sick people) are a reservoir of infection, while the contagious material is faeces, sometimes urine. The infection occurs through the ingestion, as a result of eating food and water contaminated with excrements of carriers and sick people. The disease is characterized by symptoms such as rash (so-called typhoid rubella), abdominal pain and high temperature. Its occurrence is spread all over the world, and the greatest risk of infection is in countries with low levels of hygiene in food preparation. In the event of typhus symptoms, contact a doctor immediately, as untreated ailment is a direct threat to the patient’s life. Typhoid can be prevented by immunization.

About 22 million people suffer from typhus each year, of which more than two hundred thousand people die. The regions with the highest risk of developing the disease are: South America (Peru); North and West Africa; South-East Asia and South Asia (Nepal, India).

Typhoid fever – causes

Gram-negative bacteria in the form of Salmonella typhi, from the family Enterobacteriaceae. Typhus occurs mainly in humans and the sources of infection are:

1. feces,
2. urine,
3. chronic carriers,
4. elderly people,
5. more often women,
6. people struggling with gallbladder ailments.

The ways of spreading typhoid fever include:

1. water – especially contamination of the water supply source or natural water reservoirs may result in an epidemic,
2. contaminated food products – in the form of meat, ice cream, salads or milk, which is a very good environment for the growth of bacteria,
3. insects – especially flies,
4. direct contact with the sick or the carrier – in the case of non-compliance with the rules of hygiene.

After entering the digestive tract, typhoid fever sticks locate in the further part of the small intestine (the so-called ileum) and here – penetrating through the intestinal epithelium – they enter the lymphatic system, where they multiply. Then, bacteremia occurs, and the sticks go to the liver together with the blood. In the liver and bile ducts, they multiply again and then flow with the bile into the intestinal lumen. There, the sticks and the endotoxin they produce cause inflammatory-necrotic changes. On the other hand, the toxin circulating in the blood simultaneously damages the parenchymal organs, the heart muscle, the nervous system and the bone marrow.

Other factors that increase the risk of typhoid fever include:

1. lack of hygiene in food preparation;
2. trips to endemic countries (eg South America);
3. direct contact with people who are carriers of Salmonella typhi;
4. lack of vaccinations in people who travel to places where typhoid occurs;
5. eating food from unknown sources (e.g. local street traders).

Hatching period: about 2 weeks.

Typhoid fever – symptoms

The initial symptoms are non-specific, such as malaise, mild headaches, loss of appetite, low-grade fever. The patient is weakened, complains of insomnia and pain in muscles and joints.

These symptoms increase relatively quickly within 4-6 days. The fever remains constant at 39 ° –40 ° C – the full development of the disease begins, which lasts about 2-3 weeks. The patient is lethargic, intoxicated until he is completely blackened. Characteristic for typhoid is the appearance of the tongue (inside it is covered with a dry brown coating, bright red at the edges). In addition, the spleen and liver are enlarged. The abdomen is distended and painful. Constipation occurs at first, and with the disease develops diarrhea and frequent passing of pea-like stools.

After about ten days of typhoid fever, a characteristic rash appears on the skin of the lower chest and abdomen. typhoid rubella. These are small, pale pink spots, slightly raised above the surrounding skin and disappearing when you press and stretch the skin. The rash lasts for several days and then fades away, leaving a slight discoloration of the skin. After about four weeks of illness, the temperature begins to fluctuate until it finally returns to normal. The following recovery period is characterized by increased appetite, unstable temperament, irritability, and trophic changes in skin, hair, and nails.

Typhoid fever – complications

The most dangerous complication in the course of typhoid fever is intestinal perforation with bleeding and paralytic obstruction. Other rare complications include:

1. pneumonia,
2. inflammation of the gallbladder,
3. pyelonephritis,
4. thrombophlebitis of the lower extremities,
5. children may develop typhoid meningitis and limited osteomyelitis,
6. pericarditis,
7. abscesses in the abdominal area,
8. bronchitis,
9. hemolytic anemia.
10. urinary tract infection
11. acute cholecystitis,
12. gastrointestinal hemorrhage.

Typhoid fever – diagnosis

Diagnosis is based on microbiological tests to detect Salmonella typhi infection. During the examination, the typhoid fever sticks are isolated and identified from the body fluids. The cultivation of typhoid sticks from the patient’s blood plays a huge role in diagnostics. In addition, confirmation of the diagnosis is obtained on the basis of:

1. urine culture (the second week after infection);
2. blood culture (already in the first week of infection);
3. bone marrow culture (it is performed in the most difficult cases because it is highly invasive);
4. stool culture (detection of sticks is possible between the second and fourth week after infection);
5. culture of the cerebrospinal fluid (examination performed when complications are suspected).

In our country, serological tests are also performed, which allow the detection of specific antibodies in the patient’s blood, the presence of which is visible after infection with S. typhi. Blood tests in patients with typhoid fever reveal elevated liver function tests and leukopenia.

Disease differentiation

Typhoid fever should be differentiated with the following complaints:

1. malaria,
2. sham fowl,
3. brucellosis,
4. rash typhus,
5. sepsis,
6. viral hepatitis,
7. lymphoma,
8. tularemia,
9. miliary tuberculosis,
10. leptospirosis.

Can typhoid fever be prevented?

Active prevention consists in periodic vaccination, especially during epidemic periods or when planning to travel to areas with greater incidence. Vaccines are available in three forms:

– applied deep subcutaneously and containing inactivated Salmonella typhi,

– applied intramuscularly or subcutaneously; containing the purified Vi Salmonella typhi capsular polysaccharide,

– with the lowest efficacy – an oral attenuated live vaccine

Remember to inform your doctor about any allergic or chronic medical conditions before vaccination. Various diseases may contraindicate the administration of a protective vaccine. Also, pregnant women cannot be vaccinated.

Passive prevention refers to scrupulous observance of personal hygiene (washing hands before eating, boiling drinking water). The state of municipal hygiene (sewage system, water sources) is of decisive importance. It is also important to detect and isolate the vectors, thus cutting the pathways of spreading the infection. Tests must be regularly carried out on people working in the food industry, catering and healthcare.

Other methods of prevention include:

1. avoiding contact with carriers and people suffering from typhoid fever,
2. avoiding eating food from suspicious sources,
3. in endemic regions – drinking bottled and originally packed water,
4. avoiding drinking beverages with the addition of ice, especially when it has not been prepared with pure water,
5. eating foods that are sufficiently cooked / fried / peeled,
6. avoiding eating raw fruits and vegetables.

Typhoid fever – treatment

Treatment of typhoid fever should always be performed in a hospital setting. Therapy includes antibiotic therapy (ampicillin is used). In people with bacteria resistant to this antibiotic, the following may be implemented: third generation cephalosporins, fluoroquinolones, trimethoprim / sulfamethoxazole. Treatment should last approximately two weeks.

It should be remembered that starting treatment is imperative as the symptoms of the disease will worsen and persist over a long period of time. In turn, untreated patients may develop complications in the form of infection, even leading to death.

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