Typhoid Fever: Symptoms, Causes & Treatment - MalaysiaAcute Conditions

Typhoid Fever: Symptoms, Causes & Treatment

Typhoid fever is a serious bacterial infection caused by the bacterium Salmonella Typhi. If left untreated, typhoid fever can be fatal. Learn more about its causes, signs and treatment for the condition.

Typhoid Fever

Typhoid fever, or locally known asdemam kepialu, is regarded as one of the highly contagious diseases that thrive in any environment where hygiene and sanitation are not properly observed.About 11-20 million people around the world get infected with the illness; children being the most vulnerable group. Certain regions in developing countries such as Africa, Asia, Central and South America, as well as the Middle East, are known to be the common high-risk areas. If treatment is delayed, typhoid fever can cause life-threatening health complications.

Causes of Typhoid Fever

Typhoid fever is caused by a specific type of bacteria known as Salmonella Typhi (S. Typhi) found in contaminated food, drinks, and water supply.This bacteria can get transmitted throughfaecal-oral transmission; when discharged from an infected person’s stools (poop) or urine, and then being digested indirectly by another human.

There are several ways S.Typhi can travel into one’s mouth, through the 5 Fs:

• Food: By consuming contaminated food or drinks prepared by an infected person or a carrier (a recovered person still carrying the bacteria within their body) whodoes not wash their hands thoroughly after using the bathroom.
• Fluids: By using contaminated water supply for personal hygiene (bathing, teeth brushing, hand washing) and domestic usage (vegetable and fruit gardening, growing crops, food rinsing).
• Fingers: By not washing your hands after having physical contact with an infected person, or contaminated items and surfaces.
• Fields: By pooping or urinating in open fields, bushes, and rivers (open defecation).
• Flies: By leaving meals uncovered, attracting house flies whose habitat is dirt including trash, sewage, and spoiled foods.

These habits are all a norm in our everyday life; unfortunately, we rarely pay attention to how serious the effects can pose to our health. This is why unsanitary conditions, including lack of access to clean water and irresponsible sewage disposal, contribute tohigh rates of Typhoid fever.

Signs and Symptoms of Typhoid Fever

Once S. Typhi enters your body system, this pathogen multiplies itself and spreads into different organs through the bloodstream—thus triggering a bacterial infection. The most affected organs are those found in your gastrointestinal tract, mainly the stomach and intestines. However, other organs in your digestive system such as the liver, kidneys, and gallbladder are also vulnerable to the infection if prompt action is not taken.

Here are the key symptoms of Typhoid fever:

• High fever that increases consistently each day for a long period of time
• Headache
• Constipation
• Diarrhoea
• Appetite loss
• Stomach pain or discomfort
• Muscle or body aches
• Fatigue and feeling weakly
• Dry cough

Over time, other alarming signs can also develop for example :

• Weight loss
• Hallucinations
• Rashes
• Swelling of face and eyes

If left untreated, a prolonged infection can lead to fatal complications such as organ failure, severe intestinal bleeding, and difficulty of breathing due to lung infection (pneumonia)—all of which reduce the chance of survival.

How long do the symptoms last?

These signs and symptoms typically begin to appear within 1 or 2 weeks after a person is infected by the bacteria. Mild cases of Typhoid fever last for about 3 to 4 weeks; however, delayed treatment can prolong the illness by up to a month.

Who is at risk of Typhoid Fever?

Aside from unhygienic surroundings and practices, you are more prone to get infected with Typhoid fever if you belong to any of the following groups:

• Children:The immune system of a toddler is still developing.
• Victims of natural occurrences:Floods, earthquakes, and hurricanes can cause debris to contaminate water sources.
• Travelling: Going on a trip for work or travel purposes to endemic areas (high rates of Typhoid).
• Working in a lab: Handling Salmonella Typhi bacteria for clinical studies.
• Impoverished communities: Limited access to proper sanitation.

Sanitation in developing countries

Typhoid fever in developing nations such as Bangladesh, India, and Pakistan reaches the level of endemic(frequently occurring).

In such regions, sanitation facilities are not well-provided nor well-maintained. Poverty also hinders families from being able to afford to build proper toilets. These conditions resort them to pooping or urinating out in the open like fields, bushes, and ditches which have become a daily practice. Despite the significant decrease in open defecationas a result of initiatives from the United Nations and the installation of proper toilets by respective governments,there were 494 million people who still practise it as of 2020.

Although more and more communities have been gradually adopting the use of toilets, other issues arise—such as failure to maintain a clean sewage system, loose regulations of untrained sanitation workers, unethical dumping of waste into rivers, and contaminated groundwater in public wells—continue to threaten public health.

Diagnosis of Typhoid Fever

Unattended mild cases are more likely to end up becoming severe and fatal; therefore, it is wise to not delay consultation with a doctor once you start experiencing symptoms of Typhoid fever.

Before the physical examination, the doctor will review your medical and travel records to rule out potential causes of your illness. Then, a culture test is conducted bytaking a sample either from your blood, stool, or urine. The sample will be placed under a microscope to detect the presence of S. Typhi bacteria.

As bacteria can be difficult to spot on the first observation, additional tests may be needed until a clear result is shown. One of them is toextract a culture from your bone marrowthrough biopsy by using a fine needle. It is considered a highly sensitive procedure that may cause pain, so health experts would not recommend it except as a last resort.

If you are tested positive for Typhoid,It is advisable that you be physically absent from work to prevent the bacteria from transmitting—specifically for those who have to deal with food and the public directly like food handlers, babysitters, and medical providers.The individuals you have close contact withmay also be required to undergo a similar diagnosis as well, in case the infection has spread.

Treatment for Typhoid Fever

Like most bacterial infections, Typhoid fever can be managed withantibioticsusually prescribed for the course of 7 to 14 days.

If treated early, treatment can be done simply at home by self-monitoring. Regardless, it is crucial to finish the entire prescription—even when your symptoms have already started to improve within 2 to 3 days. This is to ensure that the bacteria is completely cleared out from your body in order to reduce the possibility of returning symptoms (relapsing).

In severe cases, you may have to be admitted to the hospital and receive an injection of antibiotics, together with drips of fluids and necessary nutrients to help sustain your weak body. Surgeries are urgent for fatal complications like haemorrhage or internal bleeding in your digestive tract.

Your diagnosis will be helpful to determine which type of antibiotics is most suitable:

• Ciprofloxacin orChloramphenicol:The main option for Typhoid fever, but is often ineffective against certain species of Salmonella Typhi bacteria.
• Azithromycin or Amoxicillin:Used if the bacteria display resistance towards Ciprofloxacin.
• Ceftriaxone:Comes in the form of injections for severe infections, or for those who are not ideal to receive either of the first two types of antibiotics.

Typhoid relapses

Infected individuals may experience returning symptoms of Typhoid fever about 1 week after they complete their antibiotics—known as relapses. Fortunately, the symptoms during a relapse are expected to be milder and do not last long.

Consult your doctor immediately once your symptoms resurface to discuss the next course of treatment.

Typhoid carriers

After a full recovery, you may still carry around the S. Typhi bacteria without showing any obvious symptoms. As a Typhoid carrier, you are deemed highly contagious to the people around you and your surroundings.

There is a possibility that the bacteria stays within your body for up to 12 months or more. Hence, it is highly important that you keep track of follow-ups to undergo additional sample tests. Your doctor may prescribe you more days of antibiotics until there is zero sign of the bacteria in your stool.

Typhoid Fever Prevention

Sanitation and hygiene are two vital aspects that should be observed in our day-to-day life to minimise the risk of getting infected with Typhoid fever. We can practise various steps of prevention as follows:

At home

• Educate your family members from a young age on the importance of cleanliness.
• Make basic hygiene practices a daily habit like hand washing especially after using the toilet, before and after meals, as well as after touching animals.
• Install filtration system at home to ensure clean water supply for drinking and household usage.
• Establish a housekeeping and deep cleaning routine at least once a week, particularly in bathrooms, kitchens, and gardens or yards.
• Refrain from buying foods from street vendors, or any stalls with uncovered foods.
• If the water source is unknown, have it boiled.
• Rinse food ingredients such as poultry, fruits, and vegetables when preparing meals.
• Avoid raw and undercooked, as well as unpasteurized food products.

At daycare centres/nurseries

• Instil awareness of hygiene among the children, particularly the proper way of washing their hands.
• Clean yourself up after changing babies’ diapers.
• Always sanitise toys or items used by the children every day.
• Monitor the children from inserting items into their mouths.

Food premises

• Provide antibacterial handwash at sinks.
• Food handlers need to attend food management training to be certified by the Ministry of Health.
• Food business operators should comply withMalaysia’s Food Hygiene Regulation 2009in regards to the cleanliness of premises, food handling, compulsory vaccination, proper waste disposal, and regular pest control.
• Check the conditions of raw ingredients daily and wash them thoroughly before cooking.
• Establish a maintenance routine for public toilets, water filters, and taps.
• Prepared food should be covered at all times, or place a fly repellent fan on the food counter.

Sanitation management

• Ensure sewage treatment is maintained continuously.
• Garbage trucks should run on a fixed schedule to prevent piling up of waste that may lead to illegal dumping.
• Making waste disposal centres easily accessible.
• Establish more recycling centres to reduce waste.
• Public toilets should be in clean condition.

Vaccination

Typhoid fever vaccines are given in either two forms:

• Injections: Suitable for ages 2 and above. Booster shots are required every 5 years if you are still at risk of Typhoid fever.
• Oral/Pills: Suitable for ages 5 and above. Booster doses are required every 2 years.

However, vaccination is only 50 to 55 per cent effective and therefore is not a permanent solution to Typhoid fever. Observing hygiene practices remains a long-term safety measure.

Other than infected individuals, the Typhoid vaccine is necessary if you are:

• Food handler, or working in the food and beverages industry.
• Living with an infected person or Typhoid carrier.
• Those dealing directly with Salmonella Typhi bacteria in laboratories.
• Travelling to high-risk areas where Typhoid fever is prevalent.

You may receive Typhoid vaccines at any nearby health clinics, as well as government and private hospitals.

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References

BC Centre for Disease Control. (2012, March 15).Typhoid Fever (Salmonella Typhi).http://www.bccdc.ca/health-info/diseases-conditions/typhoid-fever-salmonella-typhi

Centers for Disease Control and Prevention. (2020, November 16).Typhoid Fever and Paratyphoid Fever – Questions and Answers.https://www.cdc.gov/typhoid-fever/sources.html

Esquander, H. (n.d.).Antibiotics 101: How It Works, Types, Benefits & More. Malaysia.https://www..com.my/health/antibiotics/

Food Handling Course In Malaysia – Why Is It Mandatory By The Ministry Of Health Malaysia?. (2019, November 9). SkillUp.https://skillup.com.my/2020/12/22/food-handling-course-in-malaysia-why-is-it-mandatory-by-the-ministry-of-health-malaysia/?utm_source=rss&utm_medium=rss&utm_campaign=food-handling-course-in-malaysia-why-is-it-mandatory-by-the-ministry-of-health-malaysia

JMP. (n.d.).Open defecation.https://washdata.org/monitoring/inequalities/open-defecation#:~:text=In%202020%2C%20more%20than%205,Saharan%20Africa%20(197%20million).

Mayo Clinic. (n.d.).Typhoid fever.https://www.mayoclinic.org/diseases-conditions/typhoid-fever/diagnosis-treatment/drc-2037866

NHS. (2021, September 20).Typhoid fever.https://www.nhs.uk/conditions/typhoid-fever/#:~:text=Typhoid%20fever%20is%20a%20bacterial,that%20cause%20salmonella%20food%20poisoning.

Senin, A. & Eksan, N. (2012, April 26).Getting Vaccinated Typhoid Fever. MyHealth Malaysia.http://www.myhealth.gov.my/en/getting-vaccinated-against-typhoid-fever/

Typhoid Fever – Causes, Symptoms & Vaccine. (n.d.). Summit Travel Health.https://summittravelhealth.com/travel-vaccines/typhoid/

World Health Organization. (2018, January 31).Typhoid.https://www.who.int/news-room/fact-sheets/detail/typhoid

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