Typhoid Treatment in Delhi, India

Typhoid is a contagious bacterial infection that can cause fever, headache, abdominal pains, and loss of appetite. Typhoid spreads throughout the body and can affect multiple organs. Most people recover quickly with prompt treatment. However, untreated typhoid can be fatal or cause life-threatening complications.

Associated Anatomy

Multiple organs

Alternate Name of Typhoid

Typhoid Fever, Enteric Fever

Typhoid Causes

• The bacteria Salmonella typhi (or S. typhi) causes typhoid. While S. typhi is not the bacterium that causes other food poisoning or foodborne illnesses like salmonella, they are related.

• typhi is transmitted through the oral-faecal route, which spreads through contaminated food or water. Furthermore, the transmission also happens due to direct contact with a patient (or person) who already has a typhoid infection.

Typhoid Symptoms

Once a person gets infected with typhoid-causing bacteria, the signs of infection will develop only after a week or two. A few prominent signs or symptoms of typhoid are:

• Persistent high fever or temperature
• Headache
• Fatigue (or extreme tiredness)
• Weakness
• Confusion
• Cough
• Bloating
• Weight-loss
• Stomach pain
• Constipation
• Poor appetite
• Rashes
• Dry cough
• Diarrhoea

Typhoid Stages

Typhoid fever has four distinct stages:

1. Stage 1: In the first stage, the patient will have preliminary symptoms of infection, such as headache, dry cough, and mild fever (only in a few cases).
2. Stage 2: This stage is marked by weight loss and a rise in fever. The stomach also becomes bloated. The patient will feel lethargic and have fever dreams or hallucinations.
3. Stage 3: In this stage, holes form in the intestine, leading to an abdominal haemorrhage. This severe stage can also cause encephalitis (inflammation in the brain). Due to acute dehydration, a person may experience a higher intensity of delirium. Furthermore, the person becomes so weak that they cannot stand or walk.
4. Stage 4: This stage involves extremely high fever with several health complications like severe infections, pneumonia, kidney failure, and inflammation of the pancreas.

Typhoid Diagnosis

To test for typhoid, you must get your stool, urine, and blood samples cultured. A bone marrow culture, which is a sensitive and complex test for Salmonella typhi, can also be done to diagnose typhoid fever.

Other tests can also be carried out to confirm typhoid infection, such as an antibodies test or a test to determine the presence of typhoid DNA in your blood. If your typhoid is confirmed, your family members will also need to take the test to check if they have been infected.

Typhoid Treatment

Antibiotic treatment is effective in the treatment of typhoid. A few common antibiotics that can be prescribed for typhoid include:

• Ciprofloxacin: Commonly used to treat typhoid, doctors often prescribe Ciprofloxacin for adults who are not pregnant. Similar to Ciprofloxacin, Ofloxacin drugs can be prescribed.
• Azithromycin (Zithromax): If Ciprofloxacin doesn’t work due to bacteria resistance, Azithromycin (Zithromax) can be used.
• Ceftriaxone: Ceftriaxone is used to deal with complicated infections. This injectable antibiotic is for those who cannot consume Ciprofloxacin, such as children.

Vaccine for Treating Typhoid Fever

Several groups of drugs and antibiotics are used to treat typhoid disease. As with the evolution of bacteria, antibiotic resistance has emerged, thus newer antibiotics are designed for curing typhoid fever. Apart from typhoid medications, typhoid vaccines play a major role in preventing and protecting people from typhoid. Two vaccines are primarily used for prevention:

• An injectable vaccine containing purified antigen from bacteria for those over 2 years of age.
• A live attenuated oral vaccine in the form of a capsule for the ones aged over five years.

However, these vaccines fail to deliver long-lasting resistance and are not recommended for children below two years of age. The World Health Organisation (WHO) prequalified a new conjugate typhoid vaccine providing long-lasting immunity in December 2017, which can be administered to children from 6 months of age.

Other typhoid treatments include

Drinking fluids

Fluids prevent dehydration due to diarrhoea or prolonged fever. Furthermore, if people get severely dehydrated, they may receive fluids intravenously (through a vein).

Maintaining Personal Hygiene

To reduce the risk of infection spreading, maintaining cleanliness and hygiene is essential. This includes washing hands with soap and warm water at regular intervals and maintaining a neat and clean environment.

Surgery

If your intestines get torn, you need a surgical process to repair them.

Risk Factors of Typhoid

You are at increased risk of typhoid disease if:

• You travel or work in typhoid-prone areas or countries, such as India, South America, Southeast Asia, and Africa.
• Your work requires handling S. typhi bacteria, or you are a clinical microbiologist working around the same bacteria.
• You come in contact with an infected person.
• You consume water or food that is affected by Salmonella typhi.

Typhoid Preventions

Primary Prevention

Before travelling to typhoid-prone regions, consider getting vaccinated. The options include:

• Oral:You can take a live attenuated vaccine for typhoid that consists of four tablets. You may consume one tablet every second day. The medication must be planned accordingly so that the last pill is taken a week before travel.
• Injection: A vaccine shot for typhoid can be administered 14-15 days (two weeks) before travel.

Secondary Prevention for Typhoid

Several secondary precautionary measures must be exercised to avoid typhoid:

Watch what you drink

• Avoid drinking tap water or directly from a well.
• Do not use popsicles or ice cubes if they aren’t made from bottled water.
• Buy carbonated bottled drinks whenever possible.
• If you are using non-bottled water, ensure that it is boiled.
• While consuming milk, tea, or coffee, ensure the milk is pasteurised.

Watch what you eat

• Refrain from eating raw produce (fruits, vegetables). Even if you consume it, ensure you wash your hands and peel them yourself.
• Avoid street food.
• Don’t eat undercooked fish or meat.
• Consume only pasteurised dairy products.
• Avoid fresh salads and condiments.

Practice good hygiene

• Keep your hands clean. Wash them often or use hand sanitisers, especially before touching food items and after using the washroom.
• Refrain from touching your face regularly with unwashed hands.
• Avoid meeting with people who are infected or sick.

Epidemiology of Typhoid

• Typhoid is prevalent in India, South America, Southeast Asia, and Africa.
• It affects about 2.7 crore people each year.
• While children remain at higher risk of getting typhoid, they tend to have milder symptoms than adults.

Expected Prognosis of Typhoid

In several cases, patients experience a relapse of typhoid fever when the symptoms return. This generally happens about a week after the antibiotic treatment has concluded. However, the relapse phase sees milder symptoms, and the illness lasts for a shorter duration than the original illness. An antibiotic treatment works best at this stage.

Natural Progression of Typhoid

If typhoid is not treated on time and allowed to progress naturally, it can cause life-threatening complications and turn fatal.

Pathophysiology of Typhoid

The pathogenesis of typhoid is influenced by factors like the patient’s immunity, infectious dose, and infectious dose. Depending on the patient’s immune system, the incubation phase lasts from 3 days to 3 weeks. During the incubation interval, a patient may have minor complaints of abdominal pain or fever. Some might not show any sign. Once the bacterium reaches a critical mass, a patient is infected with active typhoid.

Possible Complications of Typhoid

If a patient is not treated timely and with the appropriate antibiotics, they may experience complications in the third week of typhoid infection. One common complication is internal bleeding, which occurs in the digestive system. The other is the perforation (splitting) of a few parts of the bowel or digestive system, further infecting nearby tissues.

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