Typhoid is caused by the bacteria S. typhi and spread through food, drinks, and drinking water that are contaminated with infected fecal matter. Washing fruit and vegetables can spread it, if contaminated water is used.
Some people are asymptomatic carriers of typhoid, meaning that they harbor the bacteria but suffer no ill effects. Others continue to harbor the bacteria after their symptoms have gone. Sometimes, the disease can appear again.
People who test positive as carriers may not be allowed to work with children or older people until medical tests show that they are clear.
The 2 most common complications in untreated typhoid fever are:
Most internal bleeding that occurs in typhoid fever isn't life threatening, but it can make you feel very unwell.
A blood transfusion may be required to replace lost blood, and surgery can be used to repair the site of the bleeding.
Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.
Peritonitis is a medical emergency as the tissue of the peritoneum is usually sterile (germ-free).
Unlike other parts of the body, such as the skin, the peritoneum doesn't have an inbuilt defence mechanism for fighting infection.
In peritonitis, the infection can rapidly spread into the blood (sepsis) before spreading to other organs.
This carries the risk of multiple organ failure. If it isn't treated properly, it may result in death.
The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.
If you have peritonitis, you'll be admitted to hospital, where you'll be treated with antibiotic injections.
Surgery will then be used to seal the hole in your intestinal wall.
Symptoms normally begin between 6 and 30 days after exposure to the bacteria.
The two major symptoms of typhoid are fever and rash. Typhoid fever is particularly high, gradually increasing over several days up to 104 degrees Fahrenheit, or 39 to 40 degrees Celsius.
The rash, which does not affect every patient, consists of rose-colored spots, particularly on the neck and abdomen.
Other symptoms can include:
Rarely, symptoms might include confusion, diarrhea, and vomiting, but this is not normally severe.
In serious, untreated cases, the bowel can become perforated. This can lead to peritonitis, an infection of the tissue that lines the inside of the abdomen, which has been reported as fatal in between 5 and 62 percent of cases.
Another infection, paratyphoid, is caused by Salmonella enterica. It has similar symptoms to typhoid, but it is less likely to be fatal.
After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples. If a test result isn't clear, blood or urine samples will be taken to make a diagnosis.
The only effective treatment for typhoid is antibiotics. The most commonly used are ciprofloxacin (for non-pregnant adults) and ceftriaxone.
Other than antibiotics, it is important to rehydrate by drinking adequate water.
In more severe cases, where the bowel has become perforated, surgery may be required.
Typhoid antibiotic resistance
As with a number of other bacterial diseases, there is currently concern about the growing resistance of antibiotics to S. typhi.
This is impacting the choice of drugs available to treat typhoid. In recent years, for example, typhoid has become resistant to trimethoprim-sulfamethoxazole and ampicillin.
Ciprofloxacin, one of the key medications for typhoid, is also experiencing similar difficulties. Some studies have found Salmonella typhimurium resistance rates to be around 35 percent.