Typhoid fever is defined as a systemic bacterial infection that counts as the major source of illness and death in developing nations like India.

The vital source of the spread of typhoid fever is the oral-fecal route and it is mainly transmitted by contaminated food and water. Lack of access to safe water and poor sanitation of the surroundings due to contamination with fecal matter make the population vulnerable to this invasive infectious disease.

The pharmacoeconomic loss or the disease burden of typhoid is also quite high. Several research studies estimate that 11 to 21 million typhoid fever cases have been registered per year. Around 2,00,000 deaths are recorded annually worldwide as a result of typhoid-induced fatal infection or sepsis.

What causes typhoid?

Typhoid and paratyphoid are acute yet life-threatening febrile infections. Typhoid is caused by gram-negative bacteria, Salmonella enterica serotype Typhi. Whereas, S. paratyphi is the causative agent of paratyphoid.

These infections are very common in low or middle-income group countries where sewage and drinking water treatment systems are severely challenged.

Typhoid symptoms

Typhoid can be recognized with the cohort of typhoid fever symptoms like constipation, high-grade fever, chills, malaise, diarrhea, headache, loss of appetite, dizziness, acute febrile illness, and rashes on the abdominal part of the body.

Typhoid symptoms usually start a week or two after incubation of the bacteria in the body. The bacteria can also be passed through the symptom-free carriers of the disease; this typically can happen when a typhoid-infected person uses the bathroom or restroom and does not wash their hands. A classical example of this type of spreading through a carrier was seen in the Mary Mallon case.

If the illness is ignored and left untreated, then typhoid causes intestinal perforations, intestinal bleeding, and sepsis. Furthermore, some of the serious complications like opportunistic pneumonia, paranoia, nephritis, pancreatitis, and myocarditis can also get associated with the later stages of typhoid disease.

Typhoid tests

Typhoid fever can be diagnosed from the susceptible patient’s stool, urine, or blood sample.

Conventionally, typhoid is detected by a unique typhoid test, the Widal test. Recent advancements in the field of molecular immunology have led to the identification of sensitive and specific biomarkers for typhoid fever.

Typhoid can be tested and diagnosed by using Multi-Test, Dip-S-Ticks, TyphiDot, and TUBEX for the detection of antibodies IgG (Immunoglobulin G) and IgM (Immunoglobulin M). Urinary Vi antigen detection by ELISA is another promising typhoid diagnostic test if used within the first febrile week of the infection.

Typhoid treatment

Typhoid is preventable and treatable. The typhoid fever treatment includes few antimicrobial drugs (administrable through oral & parenteral routes); clinical improvement is observed in 3 to 7 days after the treatment.

Antibiotics like Azithromycin, Ceftriaxone (cephalosporin antibiotic), Chloramphenicol (second-line drug of treatment), and Fluoroquinolones like Ciprofloxacin, Ofloxacin, or Gatifloxacin (first-line drugs of treatment) are found to be effective in typhoid treatment.

If there is intestinal perforation, major surgical intervention may be needed.

Since prevention is always better than cure, it is highly recommended to adopt the following steps to prevent getting infected from the typhoid bacteria:

  • Do not eat or drink contaminated food/ liquid.
  • Always wash the vegetables/ fruits with clean water.
  • Ensure the food and vegetables should be properly cooked.
  • Always use freshly boiled and cooled water.
  • Take necessary precautions while in contact with a typhoid patient.
  • Do not defecate in the open.
  • Consume boiled milk. Similarly, consume only those milk products that are made from sterilized milk.
  • Avoid unhygienic food.

Typhoid vaccines in India

While typhoid fever can be treated well with antibiotics, increasing antimicrobial resistance has led to not only a worsening of the complications but also the severity of the illness. Therefore, an effective typhoid vaccine would prove to be an important control measure for typhoid fever.

Currently, two typhoid vaccines are available through commercial channels i.e., the Ty21a (attenuated strain of S. enterica var.Typhi, oral) and Vi (purified capsular polysaccharide S. enterica var. Typhi Vi antigen, intramuscular).

The oral typhoid vaccine Ty21a is available as an enteric-coated capsule or liquid formulation that should be given in three doses on three consecutive days. It is approved by FDA for use in children of at least 5 years of age. It generates antibodies from the 10th to 14th day after the third dose of the vaccine.

Travelers are advised to re-vaccinate themselves every year while those living in disease-endemic areas must be re-vaccinated after every 3 years. This type of vaccine is licensed to be marketed in 56 countries across the continent of Africa, Asia, Europe, South America, and the United States.

The Vi polysaccharide vaccine given as subcutaneous or intramuscular injection is certified for use in individuals above the age of 2 years. It was observed that this vaccine provides a moderate efficacy of about 3 years post-vaccination. After every 3 years, re-vaccination is recommended.

Risks from typhoid

The risks affiliated with typhoid are severe and can be fatal at times. Humans are the only host and reservoir of S. typhi. The pathogen can survive for many days in groundwater, ponds, or sea, and it can survive for months in contaminated eggs and frozen oysters.

Risk factors associated with typhoid are contaminated water supply, ice cream, flavored iced drinks or food from unhygienic street vendors, unwashed raw fruits and vegetables, and produce from fields harvested with sewage water. Individuals with a history of Helicobacter pylori infection are more prone to typhoid infection as well.

In Conclusion

Typhoid is a major public-health crisis covering most of the developing nations and emerging economies. The treatment of this vicious bacterial infection is becoming challenging day by day as a result of multiple antimicrobial drug resistance.

Effective immunization and early detection are keys to tackle this disease. New advanced diagnostic tools have been performing well in the latter case. That said, proper prevention strategies — maintaining personal hygiene and being aware of the risk factors and complications of typhoid infection — also play an essential role in managing the disease.

If you are experiencing symptoms similar to those mentioned above, along with the persistent high-grade fever, consult a physician immediately. In case you need typhoid vaccines and medicines, Wellness Forever is here for you.

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