Typhoid fever: What is typhoid and how does it manifest? Will vaccination help?

Typhoid fever is referred to as intestinal fever, but we can also find names such as typhoid fever or professionally Typhus abdominalis. It is an acute infectious disease that affects the small intestine and has general toxic symptoms. Symptoms include fever, from which the name intestinal fever was derived.

The disease only affects humans. It occurs worldwide, however, mainly in countries with low levels of hygiene, in poor areas, and where there is a high concentration of population. The risk of infection increases when traveling to these areas.

Highest geographical incidence of typhoid fever:

• landscape with warm climate
• low hygienic standard
• developing and poor countries and regions
• Asia
• Africa
• Central and South America
• popular tourist destinations
  • Turkey
  • Tunisia
  • Egypt

Approximately 16,000,000 diseases occur annually worldwide.
600,000 of them end in death.
1 in 25,000 travelers is infected with typhoid fever.
When traveling to India it is 1 infected out of 3000 tourists.

The causative agent is Salmonella enterica serotype Typhi or Salmonella Typhi for short. It is pathogenic only to humans. In addition to having an acute illness, a person can become a carrier of this bacterium.

The bacterium is resistant to low temperatures, it is not damaged by cooling or frost. Hynie at 60 ° C after 15 - 20 minutes and during pasteurization. It survives in water for about 3 weeks, in faeces also for 3 months.

Water chlorination kills bacteria.

The source of the infection is mostly a person who has an acute form of infection. However, a battery-infected bacillus carrier can spread for several years, but also for a lifetime.

Bacteria settle in the gallbladder or urinary tract, in the kidneys. Pets, such as cattle, pigs or ducks, can also be a source of infection. Bacteria can also be transmitted by flies.

The disease is one of the diseases of dirty hands.

Transmission is via the faecal - oral route, possible infection via the respiratory tract is indicated. Food products such as milk, eggs, meat or water can also cause an epidemic. Especially after contamination of food caused by improper storage, transport or insufficient heat treatment.

The danger of using typhoid bacteria as a biological warfare weapon.

Direct infection from a human or animal is also possible, but also after contact with a contaminated object. Dangerous is a carrier state when the source of infection is a person who does not know.

Symptoms of the disease appear after an incubation period, which is on average 14-16 days. The time range 7 - 24 days is also given. However, if the infectious dose of bacteria and its toxins is high, the onset of symptoms may occur in 6-36 hours. After overcoming the disease, the person retains permanent immunity.

The disease was first described in the 19th century.
In 1896, Widal's reaction was developed as a diagnostic test.

The bacterium mainly affects the small intestine, mainly the ileocecal region. The ileum is the terminal section of the small intestine and the caecum is the beginning of the large intestine. Endotoxins produced by bacteria cause inflammation of the intestinal epithelium, its swelling and necrotization (death).

Bacteria also multiply in the lymphatic tissue and are spread by lymph and blood.

The cause of the disease is infection with Salmonella typhi. The bacterium enters the body through the digestive tract, ie by ingestion (ingestion), it is classified as a disease of dirty hands. This mode of transmission is called fecal-oral. It is stated that it is also possible to inhale bacteria through the respiratory system.

The causative agent is an infected person, from the first week of the disease, but also during convalescence, ie the period of recovery. Bacteria can settle in the gallbladder and urinary tract, kidneys, which can result in  long-term to lifelong carriers. He becomes a bacillus carrier without knowing it.

Bacteria are only pathogenic to humans, however, domestic livestock, such as cattle, are also a source of infection. They are even carried by flies.

The most common sources of infection:

• infected person, bacillus carrier
• animals, and in particular bovine animals, swine or ducks
• flies and other contaminated insects
• infected food and water
  • incorrect storage or transport
  • meat
  • eggs
  • milk
  • water, infected with faeces, lack of drinking water supplies
  • vegetables watered with contaminated water
  • mayonnaise
  • spread
  • stuffing, salami, jelly
  • ice cream
• infected objects
• direct contact - human, animal, object

The symptoms of typhoid fever, ie intestinal fever, are general, but also intestinal. The name of the disease was derived from this. Salmonella typhi and its toxins damage the small intestine. In addition, they are able to multiply in the human lymphatic system.

Lymphs as well as blood are then transported across the body and digestive system.

After an incubation period of approximately 14 days, symptoms appear. Untreated disease lasts 4 weeks. After overcoming it, a person acquires permanent immunity. If there was a rapid ATB response to infection, the duration of immune memory may be shortened. Therefore, recurrent infections are very rare.

The disease has general symptoms, including headache.

Typically as an initial symptom along with fever. High body temperature, even up to 40 ° C, which  does not respond to antipyretic treatment. The long duration of a fever can lead to dehydration, which in turn leads to impaired consciousness.

TIP:  Read more about dehydration in a magazine article  on Health Care.

Man has stomach upset, anorexia and vomiting. When typhoid fever is present before constipation and not diarrhea. Approval is associated, right abdominal pain and the abdomen are swollen. The skin is pale, with characteristic pale pink rashes on the chest and abdomen, referred to as roseola.

The tongue is brown coated, the shape of the color resembles the letter V.

Other symptoms include bradycardia, which is a slowing of heart rate but also low blood pressure.

Affected by the increases in liver and spleen, so there is hepatosplenomegaly, as well as lymph nodes. The disease damages muscles, bones and can cause hair loss.

The symptoms of the disease are treatment-dependent, with early treatment shortening the duration of the disorder, which is milder. Body temperature drops by day 5. However, the disease can manifest itself in a milder or severe form.

Typhoid fever can take several forms, namely:

• outpatient typhus has a light course
  • body temperature up to 38 ° C
  • there are no complications
  • often the disease progresses and the patient becomes a carrier
• typhoid fever - if the symptoms of the disease last only 2 weeks
• Hypertox typhus is a severe form
  • high fever, hyperpyrexia
  • cardiac (heart) failure
  • sepsis, septic shock
  • unconsciousness
  • the patient dies within three days

The table shows the chronology of the symptomatology in untreated typhoid fever

The disease is characterized by the risk of complications. In the case of the digestive tract, there is a risk of damage to the intestine, its perforation and subsequent leakage of the intestinal contents into the abdominal cavity and peritonitis. Peritonitis directly threatens human life.

In case of the disease, there is also bleeding into the intestine. This then manifests as black stool, ie melena.

The person is immobilized, sweats, and it promotes the formation of bedsores. Pressure ulcers can be secondarily infected with bacteria, which again worsens the condition of humans. Other complications include inflammation of the veins, gallbladder, lungs or heart muscle.

Diagnosis of burns is based on several methods. Anamnesis, travel history and clinical course are also important. A sharp onset of intense headache and fever after traveling to high-risk areas indicates a possible Salmonella typhi infection.

In addition, laboratory tests are important, such as microbiological examination of throat swabs, sputum (mucus). Blood test, positive blood culture, cerebrospinal fluid or bone marrow. Duodenal juice or bile can also be used for diagnosis. There is the presence of Salmonella bacteria in the stool, but also numerous inflammatory cells. 

Serological examination, ie immunodiagnostics and the presence of IgM and IgG antibodies and diagnostic test by Widal reaction. As a diagnosis of the disease, namely antibodies against body antigen O, against flagellar antigen H and antibodies against antigen Vi.

The laboratory findings can be summarized as:

• anemia, which is a low red blood cell count
• leukopenia, low white blood cells
• lymphocytosis, i.e. as an increased number of lymphocytes
• aneosinophilia, decreased eosinophil levels
• thrombocytopenia, which is low in platelets
• due to worsening of liver function also impaired blood clotting, ie hemocoagulation
• cultivation evidence
• evidence of specific antibodies
• detection of nucleic acids by PCR

In case of illness, it is important to find out the cause of the difficulties early, and thus early treatment. This guarantees a milder and shorter course of the disease. Consequently, it also has an effect on the development of complications and the prevention of bacillocarriers.

The course of the disease can be typical, mild, but also shortened or severe. Untreated lasts for 3-4 weeks, which is shown in the table in the symptoms. If typhoid fever is not treated, it can go into carrier. Early diagnosis and early treatment will ensure an easier course of infection, lower body temperature values ​​and reduce the occurrence of complications.

The incubation period usually lasts 14 days, but it can also be much shorter or longer. For example, after consuming an infected food that contains large amounts of bacteria and toxins, symptoms may appear as early as 6-36 hours. But the incubation period is also 24 days.

The acute phase begins with a sudden and intense headache. It is associated with fever that does not respond to antipyretics. This is followed by anorexia and constipation. The patient may have a dry cough, which may lead to an incorrect assessment of the disease as a virus.

If left untreated, the infection continues in the typical course. The color of the tongue is brown and in the shape of the letter V or W. Two thirds of patients also have a pink rash on the torso, and thus on the lower part of the chest and abdomen. There is an associated risk of intestinal epithelial ulcers, intestinal perforation and peritonitis. 

One must think of typhoid fever if one develops symptoms and is after traveling to high-risk areas. Even after returning home, as the incubation period may be longer. Similarly, if he encountered a high-risk group of the population, which includes, for example, refugees.

Instructions on how to avoid intestinal infection

Here is a brief guide on how to avoid intestinal infections. And not just when traveling to high-risk areas of the world.

1. selection of suitable foods - the diet should be safe, heat-treated, raw foods such as fruits and vegetables washed
2. cooking food - food should be sufficiently heat treated
   • the condition is boiling at 70 ° C for 20 minutes
   • in all parts of the food, such as in the preparation of poultry at the depth of the bone
3. food must be consumed after cooking, otherwise microorganisms that produce toxins may multiply in it
4. food storage
   • temperature below 10 ° C
   • or if the food is to be warm, at a temperature of approximately 60 ° C
5. re- heating the food - at 70 and again for 20 minutes
6. beware of food contamination
   • when slicing several types of food with a knife, on a board
   • when combining already cooked and raw food
7. clean tools and food preparation environment
8. protection of food against insects and rodents
9. thorough personal hygiene and handwashing
10. drinking and safe water
11. vaccination
12. safe disposal of faeces and waste
13. epidemiological measures such as early reporting, diagnosis and treatment

Typhoid vaccination is a suitable form of prevention, for both children and adults.