TYPHOID FEVER

What is typhoid fever?

Typhoid (also called enteric fever) is an infection caused by a bacteria called Salmonella typhi. It is a serious disease that usually presents with fever and if left untreated, can cause death in up to 30% of patients. It can also cause abdominal pain, vomiting, weakness, headache and sometimes a rash. It is very common in our country and due to widespread misuse of antibiotics, many of the causative bacteria are quite resistant to commonly used drugs to treat typhoid.

How is typhoid caused?

The germs are excreted in the feces of the typhoid patient. Due to poor hygienic practices these germs can spread in the environment and are then ingested by humans. If they have not been vaccinated against the disease, then the germs can cause an infection in the intestines and then spread throughout the body causing the typical typhoid fever. Many times, the germs are carried by an otherwise healthy individual who becomes a carrier of the disease. The most notorious and the first ever identified carrier was Typhoid Mary. There are no non-human vectors (carriers) of the disease.

Which children are at increased risk of developing typhoid?

There are many risk factors:

Children receiving drugs that suppress gastric acid production like antacids, PPIs etc (in children most common usage is patients with GERD and H pylori infections): Gastric acid acts as a natural protection against infection by typhoid germs.

Environmental & Behavioral factors: this is the greatest risk factor and very difficult to control in children and include:

• Eating food from street vendors.
• Household contacts of a person suffering from typhoid.
• Washing hands inadequately.
• Sharing food from the same plate.
• Drinking unpurified water.
• Living in a household that does not have a toilet.

How does typhoid illness evolve?

After the typhoid germs enter the intestinal tract of the vulnerable host, they multiply rapidly and then enter the bloodstream and spread to all corners of the body, but are most commonly segregated in the liver and the spleen. The body responds with fever (usual response of body to any invasion by bacteria, viruses or other organisms). The fever typically is in a step wise pattern, rises to higher level, plateaus and then rises again throughout the day. By next morning, the fever becomes less. As time passes, the peaks and troughs keep getting higher. The patient then has malaise, abdominal pain (typically all over but may be localized to the right upper half of the abdomen) and constipation. The patient may develop a dry cough, dull headache in the front portion of the head, delirium, and increasingly stuporous malaise.

If not diagnosed by the second week or if treated inappropriately, typhoid fever can have very varied presentations depending on how much any of the antibiotics given have acted. If untreated child usually starts developing abdominal distention and then becomes toxic and anorexic.

How do I know that my child has typhoid fever and not any other fever?

Your doctor will examine your child and order a few laboratory tests (mainly blood tests). Additional tests may be advised if your doctor feels that your child’s condition warrants it.

My child has been diagnosed to have typhoid fever (or being treated for fever of unknown cause) andhe does not seem to be doing too well. Will he require to be hospitalized?

The most common indications for urgent hospitalization in typhoid fever are:

• When the child is unable to retain oral medications either due to nausea or vomiting or any other cause.
• When the child develops symptoms suggestive of complicatedtyphoid fever like:
  • Either black, tarry stools or any evidence of blood in stools.
  • Marked abdominal discomfort.
  • Marked neurological symptoms like delirium, decreased level of constipation, apathy etc.

What are the treatment options available?

• Well, firstly, in the acute phase of the illness, if the child is being treated on an outpatient basis, do not send the child to school until recovery.
• She should follow strict antiseptic handwashing techniques especially after defecation and before eating or drinking anything.
• She should not handle any food items either cooked or uncooked.
• She should eat a soft, light, easily digestible diet (rice, dal, khichdi, dahi rice, simple soups etc).
• Rest is preferable, though mobility is encouraged.
• Your doctor will put the child on appropriate antibiotics and of course, if the child deteriorates while under treatment, may require hospitalization and more intensive antibiotic therapy.
• The other members of the family, if unimmunized (typhoid vaccine within three years of fever) should receive immunization with typhoid vaccine.
• The child’s fever usually subsides within 4-5 days of receiving appropriate antibiotics.

Does the child require long term monitoring?

Your child can definitely have a relapse of typhoid fever (chances are 5% – 10%). Most of these relapses occur within one week of discontinuation of therapy but may occur up to 70 days later.

If your child has gallstone disease detected earlier, then the organisms hide within these stones and will require treatment of gall stones, usually (cholecystectomy).

To detect a chronic carrier state, the child should undergo stool culture every month for 3 months.

How can we prevent typhoid fever?

By paying attention to common sense general health precautions and hygienic measures, we can prevent most of orally acquired infections like typhoid, cholera, food poisoning etc.

There are typhoid vaccines available that do a good job in preventing typhoid fever though cannot completely prevent all occurrences of typhoid fever. Do contact your doctor and get your whole family immunized!