Typhoid Fever: Symptoms, Diagnosis, and Treatment Options

A persistent fever, particularly when accompanied by indigestion, should not be ignored. In some cases, it could be a sign of typhoid fever, which, if left untreated, can lead to serious complications. This makes it important to understand the symptoms of typhoid fever and recognise when medical evaluation may be needed. To help, in this article, we’ll discuss the causes and symptoms of typhoid fever, how the infection is diagnosed, and the available treatment pathways. Let’s start by understanding the condition. 

What is Typhoid Fever?

Typhoid fever is an infection that can affect several parts of the body, particularly the digestive system and bloodstream. It develops when Salmonella Typhi enters the body and multiplies, eventually spreading beyond the intestines through the bloodstream.

The infection can cause a range of symptoms, with persistent fever being one of the most common. Other symptoms may include headache, weakness, abdominal pain, loss of appetite and changes in bowel movements. Symptoms may develop gradually and can become more severe if the infection is not treated.

What Causes Typhoid Fever?

Typhoid fever is caused by Salmonella Typhi, a bacterium that infects the intestinal tract and can spread into the bloodstream. The infection is mainly transmitted through the faecal-oral route, when food or water becomes contaminated with the faeces of a person who has the infection or carries the bacteria. Common ways the infection can spread include:

• Contaminated Water: Drinking water from an unsafe or contaminated source can introduce Salmonella Typhi into the body. Water can also become contaminated when sanitation systems are inadequate or sewage enters drinking water supplies.

• Contaminated Food: Food can become contaminated when it is prepared or handled with unwashed hands, particularly by someone who has typhoid or carries the bacteria without obvious symptoms.

• Poor Hand Hygiene: Inadequate handwashing after using the toilet can allow the bacteria to spread to food, surfaces or other people.

• Poor Sanitation: Inadequate sewage disposal and sanitation can allow faecal matter to contaminate water, food and the surrounding environment, increasing the risk of transmission.

• Infected Carriers: Some people continue to carry and shed Salmonella Typhi after recovering from typhoid fever. If proper hygiene is not maintained, they can unknowingly transmit the bacteria to others.

This makes safe food and water, proper sanitation and regular handwashing important for reducing the spread of typhoid fever.

What are the Symptoms of Typhoid Fever?

Typhoid fever symptoms usually develop gradually, often beginning with a fever that becomes higher over several days. The symptoms can vary from person to person and may become more pronounced as the infection progresses. Common symptoms include:

• Persistent Fever: Fever is one of the most characteristic symptoms of typhoid fever. It may start mildly and gradually increase, often reaching a high temperature as the infection progresses.

• Headache: A persistent or recurring headache may occur along with the fever and general feeling of illness.

• Weakness and Fatigue: The infection can cause marked tiredness, weakness and reduced energy, which may persist during the illness.

• Abdominal Pain: Discomfort or pain in the abdomen may occur as the infection affects the digestive system.

• Loss of Appetite: Reduced appetite is common and may be accompanied by nausea or a general feeling of being unwell.

• Diarrhoea or Constipation: Changes in bowel movements can occur. Some people develop diarrhoea, while others may experience constipation.

• Nausea and Vomiting: Nausea can occur during the infection and, in some cases, may be accompanied by vomiting.

• Dry Cough: A dry cough may develop, particularly during the early stages of the illness.

• Skin Rash: Some people develop small, faint, rose-coloured spots on the chest or abdomen. These spots are not present in everyone with typhoid fever.

How is Typhoid Fever Diagnosed?

Since typhoid fever can cause symptoms similar to other infections, symptoms alone cannot confirm the diagnosis. A doctor considers the symptoms, then recommends appropriate laboratory tests that detect Salmonella Typhi. The main tests include:

Blood Culture

Blood culture is an important test for detecting Salmonella Typhi in the bloodstream and is generally preferred for confirming acute typhoid fever. A blood sample is examined in a laboratory to check for bacterial growth. However, the blood test may not detect every infection, particularly if antibiotics have already been taken.

Stool Culture

A stool sample can be tested for Salmonella Typhi. The test may detect bacteria being shed through the intestines, but it is generally less useful than blood culture for diagnosing an acute infection.

Bone Marrow Culture

Bone marrow culture can be more sensitive than blood culture, including in some people who have already taken antibiotics. However, it requires an invasive procedure and is therefore not routinely used for every suspected case.

Widal Test

The Widal test detects antibodies against certain Salmonella antigens. However, the test has limitations and may produce false-positive or false-negative results. A Widal test result is therefore not used on its own to confirm typhoid fever.

Are the Typhoid Test Results Always Accurate?

No. Typhoid tests can sometimes give false-positive or false-negative results, meaning the result may not accurately reflect whether a person has an active Salmonella Typhi infection. The likelihood of this can vary depending on the test used, the stage of the infection and whether antibiotics have already been taken.

False-Positive Results

A false-positive result means the test suggests typhoid fever is present when the person does not actually have an active infection. This is particularly a concern with the Widal test, as antibodies detected by the test may be present because of a previous infection, vaccination or exposure to related bacteria. This is one reason a positive Widal result should not be considered proof of typhoid on its own.

False-Negative Results

A false-negative result means the test does not detect typhoid even though the person has the infection. This can happen with blood culture if the bacterial count in the blood is low, particularly early in the illness. Taking antibiotics before the sample is collected can also reduce the chance of detecting Salmonella Typhi.

What Can Affect Results?

Several factors can influence the accuracy of typhoid testing, including:

• Stage Of Infection: The amount of bacteria or antibodies detectable can change as the illness progresses.

• Prior Antibiotics: Antibiotics taken before testing can reduce the amount of bacteria available for detection.

• Test Used: Different tests have different levels of sensitivity and specificity.

• Sample Quality: How and when the sample is collected can also affect the result.

Therefore, a negative test does not always rule out typhoid, particularly when symptoms and other clinical findings continue to suggest the infection

How is Typhoid Fever Treated?

The choice of typhoid fever treatment depends on the severity of the infection, antibiotic resistance and the person's overall health. Treatment may include:

Antibiotic Therapy

Antibiotics are the primary treatment for typhoid fever. The choice of antibiotic depends on the susceptibility of the bacteria and local patterns of antibiotic resistance. The prescribed course should be completed even if symptoms improve before the treatment ends.

Fluid Replacement

Fluid replacement helps manage dehydration caused by fever, diarrhoea or vomiting. Oral rehydration solutions may be sufficient for mild dehydration, while intravenous fluids may be needed when dehydration is severe or oral fluids cannot be tolerated.

Supportive Care

Rest, adequate nutrition and medicines to control fever or other symptoms may be recommended alongside antibiotic treatment. Supportive care helps the body recover while the antibiotics address the underlying infection.

Hospitalisation

Severe typhoid fever or complications may require treatment in a hospital. This allows close monitoring and may involve intravenous antibiotics or fluids, particularly when there is severe dehydration, persistent vomiting, intestinal complications or other signs of serious illness.

Conclusion

Typhoid fever can become serious if left untreated, so symptoms such as those mentioned above, particularly a persistent fever, should not be ignored. Prompt treatment with the appropriate antibiotics can help clear the infection and reduce the risk of complications. Consult an internal medicine specialist at Sterling Hospitals, who can help determine the cause of the fever and recommend the right treatment.