What is Typhoid Fever: Causes, Signs & Symptoms, and Different Stages

Typhoid fever is a significant public health challenge, especially in regions with inadequate sanitation and limited access to clean water. It is a life-threatening illness that predominantly affects children and young adults in developing countries. According to the WHO, approximately 11–20 million people are affected by typhoid fever each year, resulting in about 128,000 to 161,000 deaths annually. Given the gravity of the possible consequences, it becomes imperative for individuals in developing countries to understand about this disorder, which is why in this article, we explore the symptoms, causes, treatment options, and preventive measures for typhoid fever, aiming to provide a comprehensive understanding of the disease. Let’s start with some basics. 

What is Typhoid Fever?

Typhoid fever is a bacterial infection caused by the Salmonella typhi bacterium, characterised by prolonged high fever, fatigue, weakness, abdominal pain, headache, and sometimes a rash. If left untreated, typhoid fever can lead to severe complications, including intestinal bleeding or perforation, which can be life-threatening. The disease is primarily contracted through the ingestion of food or water contaminated with the bacteria, often in areas with poor sanitation and hygiene.

Who does Typhoid Fever Affect?

Typhoid fever predominantly affects populations in developing countries, where access to clean water and proper sanitation is limited. Children and young adults are the most commonly affected age groups. According to the Centers for Disease Control and Prevention (CDC), typhoid fever is more prevalent in South Asia, Southeast Asia, Africa, the Caribbean, and Central and South America. Travellers to these regions are also at increased risk if they consume contaminated food or water.

What are the Causes of Typhoid Fever?

The primary cause of typhoid fever is the Salmonella typhi bacterium, which can spread through the faecal-oral route, typically via:

• Contaminated food or water: Ingesting food or water that has been contaminated with the faeces of an infected person is the most common mode of transmission.
• Poor sanitation: Inadequate sanitation and improper disposal of human waste contribute significantly to the spread of the bacteria.
• Direct contact: Occasionally, direct contact with an infected person or carrier can also transmit the bacteria, although this is less common.

What are the Risk Factors for Typhoid Fever?

Several factors increase the risk of contracting typhoid fever:

• Unhygienic practices: When an infected person does not wash their hands properly after using the washroom and then handles food, they can easily transmit the bacteria. Additionally, touching surfaces or shaking hands with others can spread the infection.
• Open defecation: In areas where open defecation is practised, flies can transfer the bacteria from faeces to food, leading to contamination and subsequent infection when the food is consumed.
• Contaminated water sources: In regions with poor sanitation, human faeces can contaminate water supplies. Drinking this contaminated water or consuming food washed with it can lead to infection.
• Seafood consumption: Eating seafood from waters contaminated with human waste can introduce the bacteria into the body.
• Uncooked vegetables: Vegetables fertilised with human waste can harbour the bacteria, posing a risk if consumed raw or undercooked.
• Sexual contact: Engaging in sexual activities, particularly anal sex, with a carrier of Salmonella typhi can result in transmission of the bacteria.

By understanding these risk factors, individuals and communities can adopt better hygiene practices and take preventive measures to reduce the incidence of typhoid fever.

What are the Symptoms of Typhoid Fever?

Typhoid fever presents with a variety of symptoms, which can range from mild to severe. Recognizing these symptoms early is crucial for prompt treatment and preventing complications. Common symptoms include:

• High Fever: A persistent, high fever is a typical symptom of typhoid fever.
• Weakness: General weakness and fatigue are common as the body fights the infection.
• Stomach pain: Abdominal pain or discomfort, typically in the lower right quadrant.
• Headache: Persistent headaches are a frequent symptom of typhoid fever.
• Loss of appetite: A significant reduction in appetite is commonly observed.
• Rashes: Some patients develop rashes on the trunk and chest.
• Fatigue: Severe fatigue and lethargy are common, often making daily activities difficult.
• Confusion: Mental confusion or delirium can occur, especially in severe cases.
• Constipation: Constipation is more common in adults with typhoid fever.
• Diarrhoea: Diarrhoea, more frequent in children, can vary from mild to severe.

These symptoms typically develop gradually over one to three weeks after exposure to the bacteria. Early diagnosis and treatment are vital to manage the disease effectively and prevent serious complications.

What are the Stages of Typhoid Fever?

Typhoid fever progresses through several stages if left untreated, each marked by distinct symptoms.

Stage 1: Initial phase (1st week)

The fever gradually increases in severity, often reaching up to 104°F (40°C). Persistent headaches, general malaise, and a feeling of weakness are common. There is a noticeable decrease in appetite, and mild discomfort or pain in the stomach area can occur. Constipation is more common than diarrhoea at this stage, especially in adults.

Stage 2: Acute phase (2nd week)

The fever remains high and constant. Abdominal pain worsens, and diarrhoea may occur, particularly in children, while constipation continues to be more common in adults. A rash known as "rose spots" may develop on the trunk and chest. Severe fatigue and mental confusion or delirium, known as "typhoid state," are also observed.

Stage 3: Toxic phase (3rd week)

All symptoms intensify, with a high risk of severe complications. Intestinal perforation can occur, leading to severe abdominal pain and peritonitis. The bacteria can spread to the bloodstream, causing sepsis, and severe dehydration may result from prolonged high fever and diarrhoea.

Stage 4: Recovery or complications (4th week and beyond)

With proper treatment, symptoms gradually improve over several weeks. However, some patients may experience a relapse of symptoms after initial improvement. In a minority of cases, individuals may become chronic carriers of Salmonella typhi, harbouring the bacteria in their gallbladder and potentially spreading it to others.

How is Typhoid Fever Diagnosed?

Diagnosing typhoid fever involves several laboratory tests such as:

• Blood test: A blood culture is often the first test conducted. Blood samples are taken and cultured to detect the presence of Salmonella typhi bacteria. This test is most effective during the first week of infection when bacteria are present in higher concentrations in the bloodstream.
• Antibody test: The antibody tests are used to detect the presence of antibodies in the blood, which can indicate a past infection. The Widal test is a prominent example, specifically designed to identify antibodies against Salmonella typhi, the bacterium that causes typhoid fever. This test helps diagnose whether a person has been previously infected with typhoid fever by measuring the body's immune response to the bacteria. 
• Stool test: A stool sample can be analysed to identify the presence of Salmonella typhi. This test is particularly useful in diagnosing carriers of the bacteria and in later stages of the disease when the bacteria may be shed in the faeces.
• Urine test: Urine samples may also be tested for the presence of Salmonella typhi. While less commonly used than blood or stool tests, urine cultures can still provide useful diagnostic information, especially in ongoing infections.
• Bone marrow test: A bone marrow culture is considered the most sensitive test for diagnosing typhoid fever. It can detect the bacteria even when other tests return negative results, making it particularly valuable in cases of chronic infection or when previous antibiotic use has lowered bacterial levels in the blood.

These diagnostic tests, used individually or in combination, help confirm the presence of typhoid fever and guide appropriate treatment decisions.

How is Thyroid Fever Treated?

Treatment for typhoid fever primarily involves antibiotics, supportive care, and preventive measures to manage symptoms and prevent complications. Early treatment is crucial for a successful recovery.

Antibiotic treatment

• First-line antibiotics: The mainstay of treatment involves antibiotics such as ciprofloxacin, azithromycin, or ceftriaxone. These drugs help eliminate the Salmonella typhi bacteria from the body.
• Antibiotic resistance: In regions where antibiotic-resistant strains are prevalent, healthcare providers may use alternative antibiotics or combination therapies to ensure effective treatment.

Supportive care

• Hydration: Ensuring adequate hydration is vital, especially if the patient is experiencing diarrhoea. Oral rehydration solutions or intravenous fluids may be necessary to prevent dehydration.
• Rest and Nutrition: Adequate rest and a nutritious diet are important to support the immune system and overall recovery. Small, frequent meals may be easier for patients to tolerate.

Severe cases

• Hospitalisation: In severe cases or when complications arise, hospitalisation may be required. Intravenous antibiotics and intensive monitoring can help manage severe symptoms and prevent further health issues.
• Surgical intervention: If complications like intestinal perforation occur, surgical intervention may be necessary to repair the damage and prevent peritonitis.

Preventive measures during treatment

• Hygiene practices: Emphasising proper handwashing, sanitation, and avoiding food handling can help reduce the risk of spreading the bacteria to others.

Follow-up and monitoring

• Monitoring for relapse: Patients should be monitored for signs of relapse, as symptoms can reappear after initial improvement. To avoid relapses, it is important to continue its treatment and complete the treatment if symptoms subside.
• Chronic carrier state: In some cases, individuals may become chronic carriers of Salmonella typhi. Regular follow-up tests may be needed to ensure the bacteria have been completely eradicated.

Effective treatment of typhoid fever not only alleviates symptoms and promotes recovery but also plays a critical role in preventing the spread of this infectious disease.

How to Prevent Typhoid Fever?

Preventing typhoid fever involves a combination of vaccination, good hygiene practices, and careful attention to food and water safety. Here are some key preventive measures:

Water safety

• Avoid tap water: Do not drink water directly from a tap, as it may be contaminated. If there is no alternative, boil the water before consumption.
• Bottled water: Opt for bottled water, especially when travelling to areas where typhoid fever is common.
• Boiling water: If bottled water is unavailable, boil water from open reservoirs to kill any bacteria.
• Hot beverages: Drinking boiled beverages like coffee or tea is safe, as the boiling process eliminates harmful pathogens.

Food safety

• Avoid raw food: Avoid consuming raw foods, such as salads or uncooked vegetables, as they are more likely to be contaminated.
• Avoid street food: Refrain from buying food or beverages from street vendors, as the hygiene standards may be inadequate.
• Safe eating: Be cautious about what you eat and drink. Stick to well-cooked foods and avoid any items that might have been exposed to unsafe handling or preparation.

Hygiene practices

• Handwashing: Wash your hands thoroughly with soap and clean water, especially before eating or preparing food, and after using the restroom.
• Sanitation: Ensure that food preparation areas and utensils are clean to prevent cross-contamination.

Vaccination

• Get vaccinated: If you are travelling to or living in an area where typhoid fever is endemic, getting vaccinated can provide significant protection. Consult your healthcare provider about the best vaccination options available.
• In India, vaccination in every 3 years is recommended for typhoid.

General precautions

• Safe practices: Be vigilant about food and water safety, particularly when travelling to regions with poor sanitation infrastructure.
• Educate others: Spread awareness about typhoid fever prevention among your community to help reduce the risk of outbreaks.

By following these preventive measures, you can significantly reduce your risk of contracting typhoid fever and help protect those around you from this potentially serious illness.

Final words

Typhoid fever is a serious but preventable illness that requires prompt attention and appropriate care. By understanding the symptoms, stages, and preventive measures, you can take proactive steps to protect yourself and your loved ones. If you suspect you or someone you know may have contracted typhoid fever, waste no time in consulting a typhoid fever specialist at Max Hospitals, and be assured of receiving comprehensive diagnostic and treatment services.