Typhoid fever remains a serious worldwide threat especially in developing countries affecting an estimated number of 26 million or more people each year and kills an estimate of 200,000 people every year.

Typhoid fever is an acute illness associated with fever caused by the bacteria, Salmonella Typhi, which live and reproduce inside humans, Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor.

Salmonella typhi is transmitted via the faecal-oral route, spread from person to person when you eat, drink or even touch your mouth with anything contaminated with infected faeces.

How is typhoid spread?

After ingestion of contaminated food or water, the Salmonella bacteria invade the intestinal tract, are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and enter the bloodstream. Here, they multiply in high numbers and contaminate the surrounding water supply through faeces (stool), which contains a high concentration of the bacteria. For the record, the bacteria can survive for weeks in water or dried sewage.

Untreated typhoid fever is a life-threatening with long-term morbidity.

If infected people don’t wash their hands properly, the typhoid bacillus can spread directly from person to person via contaminated fingers. Here are more ways that typhoid can be spread:

• Drinking contaminated water
• Eating fresh fruits or vegetables that have been washed with contaminated water
• Eating food prepared by someone who has not washed their hands properly
• Poor hygiene practices especially after bowel movements and prior to food handling.
• Eating seafood harvested from a contaminated body of water (lake, ocean, river)
• Having oral or anal sex with someone who is infected with the bacteria

How Is Typhoid Fever Treated?

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. With antibiotics and supportive care, mortality has been reduced to 1%-2%, there is usually improvement within one to two days and recovery within seven to 10 days. Antibiotic therapy is a very effective treatment for typhoid fever.

The primary treatment for typhoid, as for most other diarrheal diseases, is oral rehydration solution. People with severe typhoid also may be treated with glucocorticoids such as dexamethasone. Diagnosed by culturing a blood or stool sample and, in rare instances, bone marrow.

Strain identification: Further testing can determine what antibiotics will be most effective against your particular strain of Salmonella typhi.

Other treatments

Drinking fluids: This helps prevent the dehydration that results from a prolonged fever and diarrhoea. If you’re severely dehydrated, you may need to receive fluids through a vein (intravenously).

Surgery: If your intestines become perforated, you’ll need surgery to repair the hole.

Symptoms and Complications

Symptoms usually appear 1 or 2 weeks after infection but may take as long as 3 weeks to appear. 

Symptoms include: Constipation, Cough, Headache, Loss of appetite, Sore throat, Fatigue or Extreme exhaustion, Shortness of breath, Pale skin, Irregular heartbeat, Vomiting blood, Blood in stools, Intestinal bleeding, Nausea, Vomiting, Fever, Chest congestion, Abdominal pain, Delirium, Diarrhoea, Sepsis (infection in the bloodstream), Generalized aches and pains, Bleeding from the rectum, Delirium, Temporary pink spots on the chest and abdomen.

Typhoid also kills by causing perforation of the small intestines, causing bacteria to pour into the abdominal cavity. This condition is called peritonitis, and is often fatal.

Other complications of typhoid occur when a large number of bacteria get into the bloodstream, causing bacteraemia. They can travel to the lungs, causing pneumonia, or to the lining of the brain, the bones, the heart valves, the kidneys, the genital or urinary tract, or the muscles. Hepatitis (inflammation of the liver) can also occur.

Prevention

Preventing typhoid is all about avoiding contaminated food and water. The same healthy practices will also help protect you from diseases such as cholera and hepatitis A, which are transmitted in the same way. Follow these guidelines to minimize your risk:

• Boil or disinfect all water before drinking it – use disinfectant tablets or liquid available in pharmacies or drink commercially bottled (preferably carbonated) beverages.
• Peel and Clean all fruit, vegetables and foods thoroughly.
• Keep flies away from food.
• Watch out for ice cubes, ice cream, and unpasteurized milk, which can easily be contaminated.
• Cook food thoroughly and eat it while it’s hot.

At present, vaccinations against typhoid provide about 50% protection for 3 to 7 years – the duration of protection depends on the vaccine used. The vaccine is available as an oral capsule and as an injection. Your doctor will determine what form is best for you or your children. Even vaccinated people must follow the food safety tips listed above. It is best to be immunized at least 7 to 14 days before possible exposure (depending on the vaccine used).

As science slowly untangles the mysteries and mechanisms of typhoid, vaccinations will be improved. For now, education and good hygiene are key to healthy