If you are familiar with the word Typhoid and malaria, I do not mean in books, I mean in person or reality, then you are from an underdeveloped country, possibly a country in Africa. In Nigeria, the word typhoid could be a prefix for malaria because people are usually infected by the two times. Today, I am discussing the prefix and not the suffix, so we will be discussing Typhoid fever. Even in the best part of Lagos, in Nigeria, people still have to buy water from another part of the state because the water is terrible. Lagosians living in the Lekki region of Lagos can relate to this. In a year, I treat myself against typhoid fever at least 3 to 4 times, not because I want to, but because I still eat a lot of roadside food, and a sachet of water (pure water) is my choice of water since I seldomly take bottle waters (I still do not see the difference in both types of water packaging only unless they are from major international companies I can trust their production system of which I trust only but a few).
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Etiology and Epidemiology
Typhoid Fever is caused by a gram-negative bacteria known as, Salmonella Enterica Serovar Typhi also known as Salmonella typhi or Salmonella paratyphi of type A, B, or C. Their clinical manifestation is quite different but the infection is known as Enteric fever which could be typhoid or paratyphoid. Transmission is from human to human, as the human is the only reservoir. It can be contacted by contaminated food and water directly or indirectly.
According to the world health organization, an estimated 11 to 20 million people get sick from typhoid in the world, and an estimated 161 thousand people die from typhoid every year. It is common in developing countries in Africa, the Americas Western pacific regions, and south-east Asia. Children and young adults are at risk of contracting typhoid fever, also people in an overcrowded region with poor sanitation and hygiene are likely to become diseased and suffer Enteric fever, also they can easily transmit it directly or indirectly.
Pathogenesis of Typhoid Fever
Salmonella typhi is ingested orally and it survives the gastric acids in the gastrointestinal tract, to enter into the duodenum (the first part of the small intestine), where it crosses the epithelial layer of the intestine through M-cells or direct penetration into the epithelial cell through Cystic Fibrosis Transmembrane conductance Regulator (a chloride ion channel in patients with cystic fibrosis) where it invades into lymphoid tissues where it causes Peyer's patch hypertrophy, after which the bacteria disseminate to other parts of the body via the lymphatic system and through blood. Infected patients will excrete the bacteria into the environment in their feces.
Clinical Presentation of Typhoid Fever
Patients with typhoid fever usually present with fever and abdominal pain. (With young boys in my country, having those clinical presentations is enough for parents and guidance to guess you have typhoid, even before you get to the hospital, but for ladies, there was a time my neighbor was going to do a pregnancy test for her child alongside the typhoid test because parents and guardians are very concerned about unwanted pregnancy) away from the serious joke, and back to the clinical presentations. The symptoms begin to show within 5 to 21 days after ingestion of the bacteria where patients begin to have Stepwise fever as the patient begins to see higher highs in temperature. the next stage is where the patient starts to feel abdominal pain and sees Rose spots. In the next stage which is usually the third week, the patient starts to experience intestinal perforation, intestinal bleeding, Hepatosplenomegaly (enlargement of the liver and the spleen), Diarrhea, Constipation, headaches, and typhoid encephalopathy which causes confusion, altered mental status, and psychosis.
Patients can experience relapse within 2 to 3 weeks after treatment, they can also be chronic carriers even after treatment, and they still pass out the bacteria in their feces.
Diagnosis, Treatment and Prevention of Typhoid Fever
Typhoid fever can be diagnosed by a clinician by confirming the fever, and gastrointestinal tract symptoms. Blood and stool cultures can be done, and empiric diagnosis can be done as well
Antibiotics can be administered orally or through IV depending on the drug treatment, and drugs to treat typhoid include Fluoroquinolones, Azithromycin, Ceftriaxone, Carbapenems, amoxicillin, TMP-SMX, and ciprofloxacin. The bacteria can be multidrug-resistant strains and that's where ceftriaxone and azithromycin can be used.
Prevention includes proper sanitation and hygiene, drinking fresh and clean water, and vaccinations. It is possible for patients to have typhoid and not be symptomatic such as in the case of Typhoid Mary, whereas the patient could be infecting others with the bacteria as they pass it out in their feces.
Conclusion
In summary, typhoid fever is a system bacterial infection that is caused by Salmonella typhi or Salmonella paratyphi. People in regions with poor hygiene and a lack of good drinking water can get people infected regularly. Developed countries do not have these cases unless they are from travelers and immigrants. Contaminated food and water are the major modes of contracting the bacteria, and human-to-human transmission is how it spread as feces with the bacteria contaminates the water and food again. It is important to know that Typhoid can lead to death if not treated immediately and properly. It is advisable to visit the hospital for proper treatment and not self-medicate to prevent complications and the bacteria from becoming a multi-drug resistanting bacteria.
https://www.who.int/news-room/fact-sheets/detail/typhoid
https://www.ncbi.nlm.nih.gov/books/NBK557513/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489205/
https://journals.lww.com/infectdis/fulltext/2006/09000/typhoid_fever__current_concepts.5.aspx
https://www.bmj.com/content/372/bmj.n437
https://www.nhs.uk/conditions/typhoid-fever/
https://www.cdc.gov/typhoid-fever/sources.html
https://resources.wfsahq.org/atotw/typhoid-enteric-fever-part-1/