What is typhoid fever?
Typhoid fever is an infectious feverish disease with severe symptoms in the digestive system in the second phase of the illness.
Classic typhoid fever is a serious disease. It can be life-threatening, but antibiotics are an effective treatment. The disease lasts several weeks and convalescence takes some time.
The disease is transmitted from human to human via food or drinking water, and it is therefore mainly hygiene and sanitary conditions that determine its spread. It is primarily for this reason that it is no longer so commonly seen in Europe.
In the UK, of the 1735 cases reported between 1980 and 1989, it is estimated that 87 per cent were infected abroad.
Typhoid fever is an infectious feverish disease with severe symptoms in the digestive system in the second phase of the illness.
Classic typhoid fever is a serious disease. It can be life-threatening, but antibiotics are an effective treatment. The disease lasts several weeks and convalescence takes some time.
The disease is transmitted from human to human via food or drinking water, and it is therefore mainly hygiene and sanitary conditions that determine its spread. It is primarily for this reason that it is no longer so commonly seen in Europe.
In the UK, of the 1735 cases reported between 1980 and 1989, it is estimated that 87 per cent were infected abroad.
human, either an ill person or a healthy carrier of the bacterium. The bacterium is passed on with water and foods and can withstand both drying and refrigeration.
As it is necessary for someone to be exposed to a certain quantity of bacteria before symptoms occur, the storage of foods is also of great significance. They must be kept refrigerated and prepared correctly, as required by general hygiene, so that any bacteria present are not able to multiply significantly.
Where does typhoid fever occur?
Typhoid fever is not a tropical disease and is related to hygiene and sanitary conditions rather than the climate itself.
Typhoid fever is found in large parts of Asia, Africa, Central and South America, where it occasionally causes epidemics. The WHO estimates that there are approximately 16 million cases a year, which result in 600,000 deaths. Many of those infected get the disease in Asian countries.
What are the symptoms of the disease?
The incubation period is 10 to 20 days and depends on, among other things, how large a dose of bacteria has been taken in.
In the mild disease, the bacterium is eliminated very early in the course of the disease and there are perhaps only mild symptoms. It is possible to become a healthy carrier of infection.
There are two phases of classic typhoid fever:
1st phase: the patient's temperature rises gradually to 40ºC and the general condition becomes very poor with bouts of sweating, no appetite, coughing and headache. Constipation and skin symptoms may be the clearest symptoms. Children often vomit and have diarrhoea. The first phase lasts a week and towards the end the patient shows increasing listlessness and clouding of consciousness.
2nd phase: in the second to third weeks of the disease, symptoms of intestinal infection are manifested and the fever remains very high and the pulse becomes weak and rapid. In the third week the constipation is replaced by severe pea-soup-like diarrhoea. The faeces may also contain blood. It is not until the fourth or fifth week that the fever drops and the general condition slowly improves.
Complications
Intestinal perforation or profuse bleeding from the intestinal mucosa may occur if typhoid fever is left untreated.
Outlook
There are good prospects of cure with antibiotics and the patient can be discharged from hospital when the general condition is stable. However, good general hygiene (as always) should be maintained in the home, as bacteria may continue to be excreted for several more weeks. If the patient is a food handler then they will need to stay off work until at least two stool samples show absence of the infection.
What can you do yourself?
There are several forms of vaccine that protect against Salmonella typhi. Most travel clinics use the injectable form (Typherix or Typhim Vi) rather than the oral form (Vivotif). The injectable vaccine is easier to administer since it only requires one dose and has less side effects. It should be administered at least two weeks prior to potential typhoid exposure and is effective for three years.
The routes of infection depend on hygiene conditions and general kitchen hygiene should be maintained to prevent infection. For travel, the same precautions can be taken as described under cholera.
How is the disease diagnosed?
The clinical picture together with information on travel may be a good pointer for the doctor in moderate to severe cases. For the final diagnosis to be established, the bacteria have to be detected in samples from the stool, blood or other tissue.
Malaria also needs to be considered as another possible explanation for the symptoms of the disease when the patient has been travelling in a malarial area.
How is typhoid fever treated?
Treatment requires admission to hospital and loss of fluid and salt is treated with fluid therapy as appropriate. The bacterium is controlled with antibiotics, and in very rare cases steroid medicines are also included in the treatment.
Prevention
Within the hospital setting, infected people are cared for in isolation. Proper hand hygiene is the most important way of preventing further spread in hospital.
Stool samples are also taken from members of the patient's family to identify any 'healthy' carriers.
As it is necessary for someone to be exposed to a certain quantity of bacteria before symptoms occur, the storage of foods is also of great significance. They must be kept refrigerated and prepared correctly, as required by general hygiene, so that any bacteria present are not able to multiply significantly.
Where does typhoid fever occur?
Typhoid fever is not a tropical disease and is related to hygiene and sanitary conditions rather than the climate itself.
Typhoid fever is found in large parts of Asia, Africa, Central and South America, where it occasionally causes epidemics. The WHO estimates that there are approximately 16 million cases a year, which result in 600,000 deaths. Many of those infected get the disease in Asian countries.
What are the symptoms of the disease?
The incubation period is 10 to 20 days and depends on, among other things, how large a dose of bacteria has been taken in.
In the mild disease, the bacterium is eliminated very early in the course of the disease and there are perhaps only mild symptoms. It is possible to become a healthy carrier of infection.
There are two phases of classic typhoid fever:
1st phase: the patient's temperature rises gradually to 40ºC and the general condition becomes very poor with bouts of sweating, no appetite, coughing and headache. Constipation and skin symptoms may be the clearest symptoms. Children often vomit and have diarrhoea. The first phase lasts a week and towards the end the patient shows increasing listlessness and clouding of consciousness.
2nd phase: in the second to third weeks of the disease, symptoms of intestinal infection are manifested and the fever remains very high and the pulse becomes weak and rapid. In the third week the constipation is replaced by severe pea-soup-like diarrhoea. The faeces may also contain blood. It is not until the fourth or fifth week that the fever drops and the general condition slowly improves.
Complications
Intestinal perforation or profuse bleeding from the intestinal mucosa may occur if typhoid fever is left untreated.
Outlook
There are good prospects of cure with antibiotics and the patient can be discharged from hospital when the general condition is stable. However, good general hygiene (as always) should be maintained in the home, as bacteria may continue to be excreted for several more weeks. If the patient is a food handler then they will need to stay off work until at least two stool samples show absence of the infection.
What can you do yourself?
There are several forms of vaccine that protect against Salmonella typhi. Most travel clinics use the injectable form (Typherix or Typhim Vi) rather than the oral form (Vivotif). The injectable vaccine is easier to administer since it only requires one dose and has less side effects. It should be administered at least two weeks prior to potential typhoid exposure and is effective for three years.
The routes of infection depend on hygiene conditions and general kitchen hygiene should be maintained to prevent infection. For travel, the same precautions can be taken as described under cholera.
How is the disease diagnosed?
The clinical picture together with information on travel may be a good pointer for the doctor in moderate to severe cases. For the final diagnosis to be established, the bacteria have to be detected in samples from the stool, blood or other tissue.
Malaria also needs to be considered as another possible explanation for the symptoms of the disease when the patient has been travelling in a malarial area.
How is typhoid fever treated?
Treatment requires admission to hospital and loss of fluid and salt is treated with fluid therapy as appropriate. The bacterium is controlled with antibiotics, and in very rare cases steroid medicines are also included in the treatment.
Prevention
Within the hospital setting, infected people are cared for in isolation. Proper hand hygiene is the most important way of preventing further spread in hospital.
Stool samples are also taken from members of the patient's family to identify any 'healthy' carriers.
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