Effect of typhoid: Typhoid Fever | Disease Directory | Travelers’ Health

14.06.202121.07.2023 by alexxlab

Typhoid Fever | Disease Directory | Travelers’ Health

What is typhoid fever?

Typhoid fever and paratyphoid fever are similar diseases caused by bacteria. Salmonella Typhi bacteria cause typhoid fever. Salmonella Paratyphi bacteria cause paratyphoid fever.

People infected with these bacteria can spread them to others. This typically happens when an infected person uses the bathroom and does not wash their hands. The bacteria can stay on their hands and contaminate everything that the person touches, including food and drinks.

In countries with poor sanitation, the water used to rinse and prepare food and beverages, including tap water, can also be contaminated with these bacteria. Travelers who eat foods or drink beverages contaminated with these bacteria can then get sick.

Typhoid fever and paratyphoid fever cause similar symptoms. People with these diseases usually have a fever that can be as high as 103 to 104°F (39 to 40°C). They also may have weakness, stomach pain, headache, diarrhea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-colored spots. Internal bleeding and death can occur but are rare.

Who is at risk?

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Typhoid and paratyphoid fever are most common in parts of the world where water and food may be unsafe and sanitation is poor. Travelers to Eastern and Southern Asia (especially Pakistan India, and Bangladesh), Africa, the Caribbean, Central and South America, and the Middle East are at increased risk for typhoid and paratyphoid fever.

People visiting friends or relatives are more likely than other travelers to get typhoid fever because they may stay in the country longer, may be less cautious about the food they eat or the beverages they drink because they eat local food prepared in people’s homes, and may not think to get vaccinated before traveling.

In the United States each year, about 425 people are diagnosed with typhoid fever and about 125 people are diagnosed with paratyphoid fever each year. Most of these people travelled internationally.

What can travelers do to prevent typhoid fever?

Getting vaccinated, choosing food and drinks carefully, and washing your hands are the best ways to avoid getting typhoid.

Check if the typhoid fever vaccination is recommended for your destination. Two typhoid vaccines are available in the United States. Visit your doctor or a travel clinic at least one month before traveling to discuss your options.

Pill vaccine. People 6 years old and older can take the pill vaccine. Finish taking all four pills (one pill every other day) at least 1 week before travel.

Shot vaccine. People 2 years old and older can get the shot vaccine. Get one shot (or a booster shot) at least 2 weeks before travel.

Typhoid vaccines are only 50 to 80% effective, so you should still be careful about what you eat and drink to lower your risk of getting typhoid fever. Also, there isn’t a vaccine that protects against paratyphoid fever. For these reasons, it’s very important that you also take the following steps to prevent typhoid.

Choose food and drinks carefully

Only eat foods that are cooked and served hot

Avoid food that has been sitting on a buffet

Eat raw fruits and vegetables only if you have washed them in clean water or peeled them

Only drink beverages from factory-sealed containers

Avoid ice because it may have been made from unsafe water

Only drink pasteurized milk

Wash your hands

Wash hands often with soap and water for 20 seconds, especially after using the bathroom and before eating

If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol

Keep your hands away from your face and mouth

After Travel

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel.

If you need medical care abroad, see Getting Health Care During Travel.

More Information

Prevention Tips for Travelers

Typhoid Fever and Paratyphoid Fever

CDC Yellow Book: Typhoid & Paratyphoid Fever

Water Disinfection

Typhoid

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Typhoid

Key facts

As of 2019, an estimated 9 million people get sick from typhoid and 110 000 people die from it every year.
Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death.
Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making treatment more complicated.
The typhoid conjugate vaccine is recommended for use in children from 6 months of age and in adults up to 45 years or 65 years (depending on the vaccine).
Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and are being introduced into childhood immunization programmes in typhoid endemic countries.

Overview

Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. It is usually spread through contaminated food or water. Once Salmonella Typhi bacteria are ingested, they multiply and spread into the bloodstream.

Urbanization and climate change have the potential to increase the global burden of typhoid. In addition, increasing resistance to antibiotic treatment is making it easier for typhoid to spread in communities that lack access to safe drinking water or adequate sanitation.

Symptoms

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death. Typhoid fever can be confirmed through blood testing.

Epidemiology, risk factors and disease burden

Improved living conditions and the introduction of antibiotics resulted in a drastic reduction of typhoid fever morbidity and mortality in industrialized countries. However, the disease continues to be a public health problem in many developing areas of the WHO African, Eastern Mediterranean, South-East Asia and Western Pacific Regions.

As of 2019 estimates, there are 9 million cases of typhoid fever annually, resulting in about 110 000 deaths per year.

Typhoid risk is higher in populations that lack access to safe water and adequate sanitation, and children are at highest risk.

Treatment

Typhoid fever can be treated with antibiotics. Antimicrobial resistance is common with likelihood of more complicated and expensive treatment options required in the most affected regions.

Even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they can spread it to others, through shedding of bacteria in their faeces.

It is important for people being treated for typhoid fever to do the following:

Take prescribed antibiotics for as long as the doctor has prescribed.
Wash their hands with soap and water after using the bathroom and avoid preparing or serving food for other people. This will lower the chance of passing the infection on to someone else.
Have their doctor test to ensure that no Salmonella Typhi bacteria remain in their body.

Prevention

Typhoid fever is common in places with poor sanitation and a lack of safe drinking water. Access to safe water and adequate sanitation, hygiene among food handlers and typhoid vaccination are all effective in preventing typhoid fever.

Typhoid conjugate vaccine, consisting of the purified Vi antigen linked to a carrier protein, is given as a single injectable dose in children from 6 months of age and in adults up to 45 years or 65 years (depending on the vaccine).

Two additional vaccines have been used for many years in older children and adults at risk of typhoid, including travellers. These vaccines do not provide long-lasting immunity (requiring repeat or booster doses) and are not approved for children younger than 2 years old:

an injectable vaccine based on the purified antigen for people aged 2 years and above; and
a live attenuated oral vaccine in capsule formulation for people aged over 6 years.

Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and are being introduced into childhood immunization programmes in typhoid endemic countries.

All travellers to endemic areas are at potential risk of typhoid fever, although the risk is generally low in tourist and business centres where standards of accommodation, sanitation and food hygiene are high. Typhoid fever vaccination should be offered to travellers to destinations where the risk of typhoid fever is high.

The following recommendations will help ensure safety while travelling:

Ensure food is properly cooked and still hot when served.
Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
Avoid ice unless it is made from safe water.
When the safety of drinking water is questionable, boil it, or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent (usually available at pharmacies).
Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet.
Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.

WHO response

In October 2017, the Strategic Advisory Group of Experts on Immunization (SAGE), which advises WHO on vaccine use, issued a recommendation for the typhoid conjugate vaccine to be added to routine childhood immunization programmes in typhoid endemic countries. SAGE also called for the introduction of typhoid conjugate vaccine to be prioritized for countries with the highest burden of typhoid disease or high levels of antibiotic resistance to Salmonella Typhi.

Starting in 2019, Gavi, the Vaccine Alliance has provided funding to support typhoid conjugate vaccine use in eligible countries.

As at March 2023, WHO has prequalified two conjugate vaccines for the prevention of typhoid. Typhoid conjugate vaccine has longer-lasting immunity than the older typhoid vaccines and can be given as a single dose to children from the age of 6 months.

In addition to decreasing the disease burden in endemic countries and saving lives, widespread use of the typhoid conjugate vaccine in affected countries is expected to reduce the need for antibiotics for typhoid treatment and slow the increase in antibiotic resistance in Salmonella Typhi.

Typhoid fever: causes, symptoms, treatment

The article was checked by a doctor: Khegai Svetlana Viktorovna

Characteristics of the pathogen and transmission

Salmonella typhi is a motile Gram-negative flagellated rod of the Enterobacteriaceae family of the Salmonella genus. It is a serious human pathogen that can only parasitize naturally in the human body. In the environment, water bodies, viability remains for several months, on fruits and vegetables – up to 10 days. A favorable environment for reproduction is individual products: milk, cottage cheese, eggs, meat, minced meat.

Help! Freezing and refrigeration does not kill typhoid bacillus, but slows down reproduction. Boiling, ethyl alcohol, ammonia, mercury chloride have a detrimental effect on the pathogen.

The source and reservoir of infection is a person whose intestines contain Salmonella typhi. For others, the patient is equally dangerous, both with obvious signs of the disease, and with an asymptomatic erased form. There is a particular risk of infection during weeks 1–5 of illness. The removal of the pathogen from the infected organism continues until the moment of complete recovery, sometimes even longer. In the chronic form of typhoid fever, a person is contagious all the time, and poses an epidemiological danger to others.

Ways of transmission of Salmonella typhi are food and water, less often contact-household. Infection enters the body through the use of contaminated water, food (kefir, sour cream, mayonnaise, yogurt, cookies, meat, minced meat), through a handshake, household appliances and items, cutlery. Insects that carry fecal microparticles on their paws take part in the spread of infection.

Immunity after typhoid bacillus is persistent. Re-infection is possible long after the initial infection or when a high dose of Salmonella typhi enters the body.

Episodes of typhoid fever are recorded year-round, an epidemic rise is observed in the summer-autumn period. The prevalence of the infection is ubiquitous, but children are predominantly affected in foodborne outbreaks, adults and adolescents are predominantly affected in waterborne outbreaks.

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Causes and pathogenesis of typhoid fever

The disease develops as a result of the interaction of Salmonella typhi with a susceptible organism under certain conditions. The causative agent enters the intestines through the oral cavity, then penetrates into the lymphatic system of the lower part of the small intestine and parasitizes. After 2–12 days, the infection enters the bloodstream and spreads throughout the body, causing changes in parenchymal organs: the liver, pancreas, and spleen.

Help! Once in the blood, the pathogen dies, but releases bacterial toxic substances that lead to intoxication of the body.

The risk of disease increases with weakened immunity, poor environmental conditions, hypothermia, swimming in polluted pools and reservoirs, stress, allergies, after prolonged contact with the carrier.

Symptoms

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Typhoid fever takes on different clinical manifestations depending on the stage of the disease, the degree of intoxication. It has a mild course, moderate and severe; is complicated and uncomplicated.

The incubation period for is 5 to 30 days (mean 10-14 days) with consecutive onset of symptoms. The reproduction of the pathogen in the lymphatic system of the intestine is accompanied by inflammation, the first signs of the disease appear: subfebrile temperature, chills, muscle and headache.

The initial period lasts 4–7 days. It is characterized by an increasing intoxication syndrome. Patients complain of lethargy, apathy, loss of appetite, sleep disturbances. The headache gets worse, the heart rate decreases. The general condition complicates flatulence, diarrhea, constipation. The root of the tongue is covered with a dense white coating, the skin is pale and dry.

The peak period of falls on the next 9–10 days. The temperature is high, the signs of intoxication are pronounced, the reactions are inhibited. Single elements of a rash appear on the body – red and pink spots 2-3 mm in diameter, which turn pale for a short time when pressed. The rash lasts up to 5 days on average, but new elements may appear throughout the entire period of fever. Rashes are localized on the lateral surfaces of the body, in the lower chest, upper abdomen. The central and basal part of the tongue is covered with a brown coating, and there is also an imprint of teeth along the edges. The liver and spleen are enlarged, blood pressure is lowered. The abdomen is swollen, there is rumbling and pain in the right iliac region, involuntary urination and defecation occurs. In a severe form of the disease, an infectious-toxic shock develops.

During the period of resolution , the temperature drops sharply, intoxication decreases, appetite appears, sleep and general well-being normalize.

The recovery period lasts 14-21 days. The size of the liver and spleen is restored, the tongue is cleansed, and the intestinal epithelium is regenerated. Relapse occurs in 3-5% of patients. Harbingers of relapse are subfebrile body temperature, weakness, malaise, enlarged liver and spleen. Relapse has the same clinical signs as the acute form of the disease, but resolves faster.

Under unfavorable conditions, complete recovery does not occur, and a period of latency sets in – bacteria and toxins are constantly excreted into the blood.

Important! The risk of chronic typhoid fever is increased by the diseases that have arisen against its background, dysbacteriosis, psycho-emotional overstrain, stress, vitamin deficiency, antibiotic and chemotherapy.

Complications

With improper treatment or use of antibacterial drugs, to which the pathogen has sensitivity, chronic bacteriocarrier is formed. A high concentration of Salmonella typhi in the human body provokes convulsions, infectious-toxic shock, cardiac arrhythmias, myocarditis (inflammation of the heart membrane).

Other undesirable effects of typhoid:

epididymitis – inflammation in the epididymis;
orchitis – inflammation of the testicles;
intestinal bleeding;
perforation of typhoid ulcer;
thrombophlebitis – thickening of the veins;
osteomyelitis – inflammation of the bone marrow;
cholecystitis – inflammation of the gallbladder;
anemia;
hepatitis is a viral infection of the liver;
meningitis – inflammation of the membranes of the spinal cord and brain;
pneumonia;
inflammation of the spleen;
cystitis – inflammation of the bladder;
infectious psychosis.

In a pregnant woman, Salmonella typhi infection increases the risk of premature birth and miscarriage. Death can occur from infectious-toxic shock, intestinal bleeding, rupture of the spleen.

Diagnostics

Typhoid fever is determined by symptoms and laboratory tests. To identify the pathogen, a bacteriological study of blood, urine, and feces is prescribed. During the recovery period, the contents of the duodenum are examined. To establish the fact of the disease, a serological test for antibodies to typhoid bacteria is performed.

If other complications are detected, an x-ray of the lungs, fibrogastroduodenoscopy, and electrocardiography are additionally prescribed.

In the first days of the disease, especially before the appearance of a rash, differential diagnosis is carried out with SARS. During the peak of the disease, pathologies that are characterized by prolonged fever and intoxication are excluded: pneumonia, collagenoses, paratyphoid fever, infectious mononucleosis, sepsis, brucellosis, typhus.

Treatment and prevention

Patients with typhoid fever are hospitalized in the infectious department. Treatment is complex, and depends on the period and severity of the disease. Particular attention is paid to patient care – prevention of bedsores, control of the condition of the stool, daily toilet of the oral cavity.

An important condition for a quick recovery is adherence to bed rest for the entire period of fever, plentiful drinking, balanced fortified. Physical activity, sudden movements, heavy lifting are prohibited. Sitting is allowed at normal temperature.

Tip! Drink at least 1.5 liters of fluid per day. It can be non-carbonated water, weak tea without sugar, compote, fruit drink.

Etiotropic therapy

Given the sensitivity of Salmonella typhi, antibacterial drugs are prescribed: fluoroquinolones, glycosides, cephalosporins, ampicillin. The duration of antibiotic therapy depends on the phenotype of the pathogen, the severity of typhoid fever. In order to prevent the recurrence of the disease, vaccination is carried out simultaneously.

To reduce intoxication, normalize the water-salt balance, detoxification mixtures (glucose, saline) are used, and glucocorticosteroids are used to restore hemodynamics. Taking into account clinical manifestations, therapy is supplemented with cardiac, sedative drugs, vitamin complexes.

The patient is discharged from the hospital after the complete disappearance of symptoms and three negative results of the study of feces, urine and blood. After discharge, follow-up is recommended.

Prophylaxis

To prevent the spread of typhoid fever, it is important to comply with the conditions for the storage and transportation of products, standards for the intake and use of water in everyday life and at work, control over the sanitary regime of public catering and the food industry.

Individual infection prevention:

compliance with sanitary and hygienic standards;
routine vaccination;
sufficient heat treatment of meat products;
thorough washing of raw vegetables and fruits before consumption;
boiling milk;
self-isolation of an infected person.

During epidemic outbreaks, it is important to avoid crowded places and use protective medical masks. If, after prolonged contact with the carrier, typical signs of infection appear, you should immediately consult a doctor.

Typhoid fever

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