Typhoid Causes, Pathophysiology, Symptoms and Treatment

Typhoid Causes, Pathophysiology, Symptoms and Treatment

Typhoid forever also knows as enteric fever

Typhoid fever is an acute illness associated with fever caused by the salmonella typhi bacteria. It can also be caused by salmonella Paratyphi, a related bacterium that usually causes a less severe illness.

Major causes morbidity & mortality

Food waterborne disease

The bacteria are deposited in water or food by a human carrier and then spread to other people

Typhoid Causes

  1. bacteria

Caused by bacteria- salmonella typhi

Family- Enterobacteriaceae

Gram-negative bacilli

Best grows at 300 c

2. transmission

Faecal-oral route

Close contact with patients / carrier

Contaminated water and food

Flies & cockroaches

Typhoid fever is highly contagious an infected person can pass the bacteria out of their body in their stools (faeces) or, less commonly, in their urine

Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage

A person with typhoid fever is contagious anywhere from a day to a year. (if they become a chronic carrier) some researchers suggest a few individuals may be contagious. Indefinitely

About 3 to 5% of people become carriers of the bacteria after the acute illness

With appropriate antibiotic therapy, most patients recover from the disease

Typhoid Pathophysiology

Typhoid Symptoms

The incubation period is typically about 10-14 days but can be longer and the onset may be insidious

Symptoms are often non-specific and clinically non-distinguishable from other febrile illnesses, however, clinical severity varies and severe cases may lead to serious complications or even death

Clinical features of Typhoid

Stage 1 (1st week)

  • Slowly rising of temperature for 4-5 days
  • Abdominal pain & myalgia
  • Malaise
  • Headache
  • Constipation
  • bradycardia

Stage 2 (2nd week )

  • Signs & symptoms of 1st week progress

End of 2nd week

  • Delirium, complications then coma & death
End of 1st week
  • Rose spots may appear on the upper abdomen & on the back of spares
  • Cough
  • Splenomegaly
  • Diarrhea
  • Abdominal distension

Stage 3 (3rd week )

  • Febrile become toxic & anorexic
  • Significant weight loss
  • Apathy, confusion, psychosis
  • High risk of haemorrhage & perforation may cause death

Stage 4 ( 4th week )

Recovery period

If the individual survives to the 4th week the fever, mental state and abdominal distension slowly improve over a few days

Intestinal & neurologic complications may still occur in surviving untreated individual

Weight loss & debilitating weakness last month


The course tends to be shorter and milder than that of typhoid fever and the onset is often more abrupt with acute enteritis the rash may be more abundant and the intestinal complications less frequent

Complications of typhoid

1.Bowel→perforation, Haemorrhage

2.Septicaemic foci → bone & joint infections, meningitis, cholecystitis

3.Toxic phenomena→ myocarditis, nephritis

4.Chronic carriage →persistent gallbladder carriage

Diagnostic& investigation of typhoid

1.Blood culture

2.Specific serologic test

-Identity salmonella antibodies/ antigen

-widal test & ELISA

3.Urine & stool culture (1st & 3rd weeks)

4.Marrow culture

-Widal test→ tube agglutination test

-Detects o & H antibodies

-Diagnosis pf typhoid & paratyphoid

-Testing for H agglutinins in dryers tube narrow tube floccules at the bottom

-Testing for an agglutinin in Felix tube

-Incubated at 370c overnight

Treatment for typhoid

  • Rest
  • Medical care
  • Antibiotics – chloramphenicol, ampicillin, fluoroquinolone, azithromycin
  • Corticosteroid
  • Antipyretics
  • Diet – fluid & electrolytes should be monitored soft digestible diet is preferable in absence of abdominal distension & ileus
  • Surgical care – in case of intestinal perforation
  • Cholecystectomy may be necessary
  • Precaution for typhoid
  • Hand wash
  • Drink boiled water
  • Clean fruit & vegetables
  • Get vaccinated
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