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The latest global evaluation of the World Health Organization (WHO) estimates typhoid-related deaths ranges from 1,28,000 to 1,61,000 per year. According to this estimate, ~11–21 million typhoid cases are annually recorded. The prevalence of typhoid in Africa, South East Asian countries, Western Pacific countries, Central and South America and India is commonly reported. These areas have poor water quality and sewage sanitation. Typhoid, a gastrointestinal infection, is characterised by high diarrhoea, vomiting fever and is caused by a bacterial infection known as Salmonella typhi (S. Typhi). An individual can get infected with these bacteria by ingesting contaminated food or water. Moreover, typhoid fever is referred to as enteric fever, which describes both typhoid and paratyphoid fever. The illness course extends to unspecified body system-related diseases from the early digestive system distress and eventually to multiple complications. Salmonella spreads through the faecal-oral route through contaminated water, undercooked food, fomites of the infected patient, and more common areas with overcrowding and poor sanitation. Individuals suffering from typhoid fever carry the bacteria in both their bloodstream and intestinal tract.

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There are no reported types of typhoid.


There are no known stages of typhoid


Typhoid patients can experience the symptoms of typhoid for 7–14 days after exposure to typhoid bacteria. The approximate duration of typhoid illness is in the range of 3–4 weeks varying on severity. The incubation period of typhoid bacteria is 7–14 days. During typhoid, there is a gradual rise in temperature (step ladder pattern).

Here are certain prominent symptoms:

  • Headaches

  • Constipation or diarrhoea

  • High fever (103 °F)

  • Lethargy

  • Poor appetite

  • Enlarged spleen and liver

  • Rose-coloured spots on the chest

  • Chest congestion

  • Abdominal pain

  • Fatigue

  • Chills

  • Generalised pain and weakness

Causes And Risk Factors


Typhoid’s primary cause is Salmonella typhi; this illness spreads via food, drinking water and drinks that become contaminated because of typhoid-infected faecal matter.[11] An individual contracts typhoid fever through drinking water and eating foods contaminated with faecal matter, containing a greater volume of Salmonella typhi bacteria. The infected individual’s stool can spoil the entire supply of water around a typhoid patient, which can cause the contamination of the whole food supply chain around him. Moreover, typhoid can be spread through asymptomatic typhoid carriers, which indicates that they foster the bacteria but experience no ill effects. In such people, typhoid can appear.

Risk Factors

Typhoid-related infection is associated with various risk factors, including age, sex, poor sanitation, consumption of unwashed produce, contaminated water, and poor handwashing practice.


WHO recommends two vaccines for typhoid prevention. One is weak, life and orally administered, while the other is an inactivated vaccine shot.

Vaccine shot: Anyone above the age of 2 is advised with this vaccination injection. High-risk category people are recommended to have repeated doses.

Oral vaccine: People over the age of 6 can be given this vaccination. It is available in a pack of four tablets, four out of three of which have to be taken on alternating days. Your physician may suggest you take the last one a week before going to a place with high typhoid prevalence. The ideal time to take each capsule is an hour before a meal. Preferably, you should have it with cold or lukewarm water. This vaccine’s repeated booster dose is recommended by doctors every five years for people in a high-risk zone.


Physicians suggest certain tests if your symptoms suggest typhoid. Blood culture, stool culture, and urine culture are the laboratory investigations used to confirm Salmonella typhi. Typhoid bacteria are considered to be present in the bone marrow, which is most sensitive for this bacteria. Moreover, the doctor may suggest laboratory investigations to investigate typhoid-related antibodies. Although a blood culture is a preliminary test for diagnosing typhoid-related fever, only 40%–60% of tests show a positive result in the early phase of the illness. Urine and stool culture show much lower sensitivity and become positive after the first week of infection.

Other blood tests such as blood leucocyte count are usually less because they are associated with fever. Leucocytosis in younger children is a common co-relation, and the count may range from 20,000 to 25,000/mm3. A marker for severe disease and related disseminated intravascular coagulation can be thrombocytopenia. Although liver function tests may be abnormal, notable hepatic dysfunction is infrequent.


The high efficacy rates of chloramphenicol for treating S. Typhi and Salmonella Paratyphi are evident. Chloramphenicol often remains the first line of treatment of typhoid fever. There is an emergence of multidrug-resistant Salmonella typhi infected, making it necessary to explore different therapeutic options. Generally, Ceftriaxone is an antibiotic given for typhoid treatment because of its high efficacy to treat S. Typhi infections. Ceftriaxone has been known as a standard of care for typhoid. Ceftriaxone is required to be given by parenteral administration because of which less adherence to this antibiotic is noted. Another alternative treatment option for S. Typhi infections is the use of azithromycin. The growing emergence of antibiotics resistant to S. Typhi is the present concern. Drugs such as ampicillin and trimethoprim have diminished activity in treating S. Typhi infections because of multi-drug resistance. Because of rising antimicrobial resistance, S. Typhi is resistant to trimethoprim-sulphamethoxazole, ampicillin, chloramphenicol, sulphonamide, streptomycin and tetracycline. This is a crucial factor that affects drug selection. In uncomplicated typhoid, fluoroquinolone-like ciprofloxacin or levofloxacin are given for 10–14 days. In complicated typhoid, 2 g of ceftriaxone IV is given azithromycin for 7 days, added nowadays alone with ceftriaxone. The role of glucocorticosteroids in treating severe typhoid fever has been noted based on a clinical trial conducted in Indonesia. One of the adverse events because of corticosteroids has been in masking intestinal perforation; therefore, corticosteroids are reserved for severely ill patients. Other factors that influence the recovery from typhoid fever are ideal nursing practices.


Moreover, people with typhoid fever complain of gastrointestinal or digestive problems. The symptoms associated with this bacterial infection are loss of appetite and nausea. A well-planned diet will help manage typhoid in a significant amount. For individuals living with this condition, nutritionists and doctors recommend small, everyday meals. Moreover, they advise patients with typhoid to use simple foods because, during the bacterial infection, the digestive tract does not correctly work. If you treat typhoid, you should ideally preserve a balance of carbs, fats and proteins. To ease symptoms to make the healing process smooth, follow these food rules; go for a high-calorie diet. Typhoid disease can lead to unnecessary weight loss. A diet full of calories helps you maintain your body weight healthy. Boiled potatoes, bread, and bananas can be a nice choice. Have plenty of fluids, and high fever and diarrhoea are presented with typhoid, both of which lead to dehydration. Depleted fluid levels can cause typhoid treatment complications. Ensure you drink sufficient water and juice of fresh fruit. Depend on semi-solid foods such as cooked rice and baked potato. You can easily digest them and include protein-rich foods such as legumes, cheese and yoghurt in your meals. However, avoid meat because it may be hard to digest. Avoid high-fibre, spicy and deep-fried foods, whereas butter, Ghee, and dairy products should be consumed less.

Prognosis And Complications


Current advancements in typhoid fever treatment have decreased the fatality rate, which is a significant problem in South Asia and African countries. A 1% reduction in a fatality has been noted, which is substantial compared to 12.75% mortality in the 1940s. This is because typhoid-related treatment during the 1940s was supportive and symptomatic. An effective approach to avoid complication is prompt diagnosis and treatment. As the treatment advances, the mortality reduces.


Typhoid fever causes various complications in an infected human. The gastrointestinal tract is the primary target of invasion for S. Typhi bacteria, leading to diarrhoea, obstruction of lumen, and constipation. The large volume of watery diarrhoea can progress to dysentery. The spread of bacteria around the body systems can lead to multiorgan failure because of blood infection. Complications such as encephalopathy and hepatitis are evident. Respiratory complications such as emphysema, lung abscess and bronchopleural fistula can be noted in lung cancer patients and other lung illnesses. Neurological complications such as acute psychosis, meningitis, sleep disturbances, and muscle rigidity are observed In untreated cases; 30% of the cases develop either intestinal haemorrhage or intestinal perforation. In the third week, raised leucocyte count and tachycardia are warning signals, urinary intention pneumonia, thrombophlebitis (blockage in veins), myocarditis, inflammation in the gall bladder, psychosis, and infection going to kidney and brain are other complications of untreated typhoid.

Alternative Treatments

Other than vaccines, there are other steps that you can follow to keep typhoid at bay:

  • Maintain ideal hand hygiene and wash your hands frequently preferably before having a meal and after using the washroom.

  • Avoid street foods as they can be the breeding grounds for typhoid bacteria.

  • Ensure to wash your utensils with clean water.

  • Consume hot and fresh food as the growth of bacteria is hindered by high temperature.

  • Avoid eating untreated or contaminated water and eating raw veggies and fruit.

  • Keep your household goods well-cleaned and sanitary (particularly in the kitchen).

Vaccination is an ideal approach for you to travel to anywhere in the world that can place you at high risk for typhoid infection.



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