Typhoid fever: causes, symptoms, treatment
Typhoid fever is an infectious disease that can be dangerous if left untreated. The trigger is a certain type of bacteria, namely salmonella. A distinction is made between abdominal typhoid fever (typhus abdominalis) and the typhoid-like disease (paratyphoid fever) – it is the attenuated form. Typhus is treated with antibiotics. Read more about symptoms and treatment of typhoid fever.
The word typhoid comes from the Greek: typhos means ‘haze’, ‘fog’, ‘vertigo’. This refers to the neurological typhoid symptoms that a patient may develop.
Typhoid fever is a severe diarrhoea caused by bacteria (Salmonella typhi). Doctors distinguish between abdominal typhoid fever (typhoid abdominalis) and typhoid-like disease (paratyphoid fever). Every year around 22 million people worldwide contract typhoid fever – the number of deaths is estimated at 200,000 per year. Children between the ages of five and twelve are most frequently affected. For paratyphoid fever it is assumed that 5.5 million cases of the disease occur every year.
Although the disease occurs worldwide, it is mainly spread in developing countries where poor hygienic conditions prevail. Africa, north of South America and Southeast Asia are known to have particularly high rates of disease and repeated outbreaks and epidemics.
If there are cases of typhoid fever in the United States or the European Union, the disease is mainly introduced by travellers coming from tropical countries. The highest risk of infection is in India and Pakistan. Typhus is a notifiable disease.
There is a typhoid fever vaccination, which can be used to prevent the infection when travelling abroad.
Typhoid fever: symptoms
The following symptoms may occur in abdominal typhoid and paratyphoid if the disease is left untreated:
Typhoid fever (Typhoid abdominalis)
- uncharacteristic complaints such as headaches and aching limbs
- within two to three days fever between 39°C and 41°C, which slowly increases and can last up to three weeks; a general feeling of illness develops
- Abdominal pain
- possibly first constipation, from the second week on pap-like diarrhoea
- Characteristic, but rare, are non-itching, pinhead-sized, reddish spots on the belly, chest and back.
- thick, whitish or greyish white coating on the main part of the tongue, raspberry red tip and edges
Typhoid-like disease (paratyphoid fever)
The course of paratyphoid fever is similar to that of typhoid fever abdominalis, but the symptoms are usually less pronounced. In the foreground are more often nausea and vomiting, watery diarrhoea, abdominal pain and fever up to 39 °C. The disease lasts between four and ten days.
Anyone who has survived a paratyphoid disease is immune for about a year. However, if affected persons are exposed to a high dose of the pathogen, immunity may be lost again.
Typhoid fever: causes and risk factors
The triggers of typhoid fever are salmonella. Typhoid abdominalis is caused by the bacterium Salmonella enterica typhi and paratyphoid by Salmonella enterica paratyphi. These bacteria are spread worldwide.
People become infected mainly by ingesting contaminated water and food contaminated by infectious faeces (stool, urine) – for example, fruits and vegetables fertilized with faeces when eaten raw. Shellfish from areas where the water is contaminated are also an important source of infection. Even flies can transmit the pathogens to food. Direct transmission from person to person is also possible, especially via the hands.
The time between infection and the outbreak of the disease (incubation period) is about 2 to 21 days (usually 10 to 14 days) for typhoid fever and about 1 to 10 days for paratyphoid fever.
There is a risk of infection for other people about a week after the onset of the disease because the germs are excreted with the stool. Even weeks after the typhoid symptoms have subsided, some people still excrete bacteria. In two to five percent of the cases, infected persons even excrete the pathogen for life without feeling any symptoms. Doctors refer to these persons as permanent excluders. These can also be a source of infection for others.
Typhoid fever: examinations and diagnosis
At the beginning of the typhoid diagnosis is the interview (anamnesis). Particularly important, for example, are trips to typhoid regions or longer stays abroad by the patient. Typhoid and paratyphoid diseases are often confused with flu-like infections in the beginning. When returning from the tropics, there is also a danger of confusion with malaria and other tropical diseases. If a patient develops a disease with high fever after appropriate travel and if it lasts for more than four days, an infection with typhoid or paratyphoid fever must be considered.
A blood test helps to diagnose typhoid fever or paratyphoid fever – thus a reliable detection is possible. The blood count shows certain changes, for example a reduction in white blood cells. The pathogen can also be directly detected in the blood. After some time the bacteria are also found in urine and stool.
When the bone marrow is examined, typhoid or paratyphoid fever can be detected even after the disease has healed.
Typhoid fever: treatment
Typhoid fever and paratyphoid fever are very serious diseases that can take a serious course. Patients should always be treated with antibiotics. The active ingredient ciprofloxacin is very effective, but it is only suitable for adults. Suitable substances are also ceftriaxone, cotrimoxazole and amoxicillin. The classic therapy with chloramphenicol has more possible side effects with the same or less effectiveness – it is therefore no longer the remedy of choice.
Antibiotics are usually taken in tablet form. In the case of particularly severe disease progression, the substances are administered in hospital as an infusion. The therapy usually lasts for two weeks, whereby a decrease in fever is expected after four to five days. A typhoid therapy with antibiotics that fight the bacteria is very successful, especially in the early stages of the disease. Mortality is then usually below one percent and complications are rare.
Permanent eliminators are recommended to take ciprofloxacin over a period of four weeks. Good results can also be achieved by a two-week therapy with ceftriaxone. In typhoid patients with gallstones, the typhoid bacteria can settle in the gall bladder. In such cases one must consider removing the gallbladder.
A major problem is that increasingly resistant germs are developing in the typhoid regions, against which common antibiotics such as Cotrimoxazol or Amoxicillin are no longer effective. Experts therefore recommend testing the efficacy on isolated pathogens before treatment.
Typhoid fever vaccination: There is a vaccination to protect against abdominal typhoid fever (Typhoid fever abdominalis). It is recommended for people travelling to risk areas with poor hygienic conditions. The typhoid vaccination is administered by syringe and provides protection for about three years. Oral typhoid fever vaccination (oral vaccination) is also possible, which provides immunity for about one year. However, even the typhoid vaccination does not offer 100 percent protection. Only in about two thirds of the cases can an outbreak of the disease be prevented. But the typhoid vaccination can alleviate the course of the disease. There is no vaccination against the typhoid-like disease (paratyphoid).
You can read everything important about the typhus vaccination in the article Typhus vaccination.
Hygiene: Targeted hygienic measures that can protect against infection with typhoid bacteria are also important. Typhoid pathogens are mostly transmitted via drinking water. It is therefore best to keep your hands off tap water or water from the well in the risk areas. Ice cubes made from tap water are also rather taboo.
Avoid raw or insufficiently heated food. These include leaf and delicatessen salads, seafood, unpeeled fruit or juices – they can be contaminated with typhoid and paratyphoid pathogens. You’d better follow the rule: “Peel it, cook it, or forget it!” .
If you have contact with typhoid patients or known permanent eliminators, you should wash and disinfect your hands frequently.
Patients with typhoid fever should drink a lot to compensate for the loss of water. The electrolyte balance (blood salts) must also be brought back into balance. In addition, hygiene is extremely important in order to prevent infection of contact persons.
Typhoid fever: course of disease and prognosis
With early treatment with antibiotics, the prognosis for typhoid and paratyphoid fever is very good. Compensating for the large loss of fluid also contributes to a rapid recovery. The mortality rate is less than one percent. However, some of the patients can become so-called permanent dropouts. This means that they excrete the pathogen over a long period of time although the symptoms have already subsided. They must be treated accordingly, otherwise there is a permanent risk of infection for their fellow human beings.
If a disease with typhoid or paratyphoid fever remains untreated, the prognosis is much more critical. Before antibiotics were available, about 15 to 20 percent of patients died.
This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical experts.
ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity to work.
- Marre R. et al.: Clinical Infectiology. Urban & Fischer publishing house. 2. Edition 2008
- Herold G.: Internal Medicine. Self-published. 2017