Typhoid fever – causes, ways of transmission and treatment

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Typhoid fever – how is it transmitted?

The sources of infection in the case of enteric fever are represented by:

• Patients with typhoid fever
• Asymptomatic healthy carriers of the typhoid bacillus
• Chronic carriersin which the elimination of the pathogen is constant over a period of several years.

The infectious pathogen is transmitted through the urine, feces, bile and purulent secretions of the sick, which can contaminate water and food sources.

After the ingestion of contaminated food and water, the typhoid bacillus multiplies in the digestive tract, causing inflammation of the mesenteric ganglia and subsequently spreads throughout the body, through the blood circulation, generating the appearance of symptoms specific to the typhoid state.

The main virulence factors of the tific bacillus are represented by adhesiveness, the capacity for invasiveness and toxigenesis, Salmonella typhi being able to synthesize a toxin called typhoid toxin A2B5.

The enterotoxin synthesized by the typhoid bacillus shows high cellular toxicity, being capable of inducing tissue necrosis and generating the appearance of a non-specific immune response manifested by inflammation and fever.

Geographic risk areas for typhoid fever

The World Health Organization estimates that typhoid fever annually affects between 10 and 20 million people worldwide.

Infection with the typhoid bacillus is more common in the developing countries of Latin and South America, India, Pakistan, China, Laos, Nepal, Indonesia, Vietnam or Egypt.

Interhuman transmission of the pathogen that causes typhoid fever is favored by unsanitary living conditions, poor public and personal hygiene.

Vaccination against typhoid fever

The most effective method of preventing infection with the typhoid bacillus is represented by vaccination against typhoid fever with typhoid vaccine. Active immunization against typhoid fever it is recommended both to people who live in endemic countries, and cthose who travel to regions of the globe where the incidence of this pathology is highthe medical and military personnel who carry out their activity in these areas.

Each dose of typhoid polysaccharide vaccine contains capsular polysaccharide purified by Salmonella typhi and provides protection against infections generated by the Ty2 strain. The vaccine can be administered to adults, adolescents and children older than 2 years in a single dose, at least 2 weeks before a potential exposure in case of travel to endemic areas. People who live in geographical areas with a high risk of contracting the typhoid infection are indicated for revaccination every 3 years.

Medicover international vaccination centers

If you are planning a trip to areas with high epidemiological risk, we recommend that you consider active immunization before reaching your destination.

You can address Medicover International Vaccination Centers for administering the recommended vaccine doses and for requesting more information about prevention depending on the area where you are going to travel:

Medicover international vaccination centers in Bucharest:

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Medicover international vaccination centers in the country:

Learn more about Prevention of infectious diseases during travel in exotic countries

Symptoms of typhoid fever

The main symptoms that make up the evolving clinical picture of patients with typhoid fever are represented by:

• Chills
• Intense headache
• Insomnia
• Integumentary manifestations in the form of typical roseola eruptions
• High fever 39-40°C.

Digestive manifestations encountered in patients with typhoid fever are frequently represented by salivary hyposecretion, pharyngeal congestion and Duguet’s angina (small, oval, superficially and symmetrically arranged ulcers at the level of the pillars and the palatine wave, which appear during the period of typhoid fever, usually in a two weeks of evolution of the infection with S. typhi) which corresponds to intestinal ulcers.

Dissemination of the pathogen from the intestinal level into the bloodstream can occur even in the absence of digestive manifestations, the bacillus reaching the level of the liver, spleen or pancreas through the macrophages inside which it actively multiplies.

Cardiovascular manifestations are caused by the action of the enterotoxin synthesized by the typhoid bacillus and may include:

• Hypertension
• Irregularities of the heart rhythm with the appearance of tachycardia
• Hemorrhagic syndromes such as epistaxis (nosebleed) and gingivorrhagia (bleeding gums).

After the first week of evolution of the infection, the so-called can be installed stay cheering manifested by marked apathy, obscurity and delirium.

Complications of typhoid fever

Complications that can occur during the evolution of the infection with Salmonella typhi they are represented by:

• Intestinal perforation
• Acute surgical abdomen
• Digestive bleeding is caused by intestinal ulcers
• Myocarditis (inflammation of the heart muscle) or toxic endocarditis (inflammation of the endocardium)
• Mycotic aneurysm secondary to fungal infection of large blood vessels in the body
• Toxic hepatitis
• Pneumonia
• Encephalitis, meningitis
• Polyradiculoneuritis
• Infections of the excretory system (kidney infections) or of the gall bladder.

Typhoid fever treatment

The treatment of typhoid fever is etiological and aims to eradicate the bacterial pathogen that induces the appearance of specific manifestations.

Antibiotic treatment prescribed to patients with typhoid fever frequently includes fluoroquinolones, cephalosporins, macrolides and carbapenems.

Drug management of due infections St. typhi must be applied strictly in accordance with the recommendations of the attending physician to prevent the selection of multidrug resistant strainsmore and more frequently encountered in current medical practice.

In severe forms of typhoid feverthe infectious disease doctor can opt for the use of cortisone-based medicinal preparations in order to reduce the risk of inflammatory complications in the central nervous system – encephalitis, polyradiculoneuritis.

Surgical treatment in the case of typhoid fever it is recommended in the following situations:

• Gallbladder resection in the case of patients with chronic infection with typhi. In certain situations, the infection with the typhoid bacillus can evolve for a period of several decades, during which the patient, although asymptomatic, actively disseminates the pathogen through the faeces, constituting a risk for the people around.
• Intestinal perforation
• Intestinal hemorrhage.

The supportive treatment of patients with typhoid fever includes bed rest, especially during feverish periods, a liquid diet and the administration of vitamins from group B, vitamin C and K.

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