Typhoid fever (enteric fever) is a systemic disease caused by Salmonella typhi. Typhoid fever occurs where sanitary conditions are poor permitting contamination of food or water with faeces.
Typhoid bacilli are shed in stool of asymptomatic carriers or in stool or urine of people with active disease. The bacteria which are spread by the faeco-oral route invade the intestined wall and spread through the bloodstream to all organs.
Organisms may continue to be present in the stool of healthy carriers i.e. patients with positive stool culture.
Typhoid fever may result in complications such as intestinal perforation with peritonitis, acute psychosis, bloodystools, and severe intravascular haemolysis leading to acute kidney injury (especially in G6PD deficiency)
Symptoms of Typhoid Fever
- Fever which increase gradually to a high fever and persists for weeks
- Headache (severe)
- Constipation in the early stages
- Abdominal pain and tenderness
- Anorexia
- Psychosis and confusion may occur
- Nonproductive cough
- Arthralgia
- Pharyngitis
- Dysuria
- Epistasis
Signs of Typhoid Fever
- High fever with a relatively slow pulse rate
- Hepato-splenomegaly(tender)
- Confusion
- Signs of chest infection
- Abdominal tenderness
Investigations
- FBC
- RDT/blood film for malaria parasite (to exclude malaria)
- Stool culture
- Urine culture
- Blood culture
Diagnosis
Diagnosis of typhoid fever is based on a clinical suspicion backed by the following investigations:
- Stool culture
- Urine culture
- Blood culture
The above tests are superior to the widal test
Treatment
Treatment objectives
- To prevent transmission of infection to other people
- To eradicate the infection
- To detect and manage complications
Non-Pharmacological Treatment
- Tepid sponging to reduce body temperature
Pharmacological Treatment
Preferred antibiotics used in the treatment of typhoid fever include:
- Ceftriaxone 1g IM or IV 12 hourly (25 to 37.5mg/kg in children) for 14 days
- Fluoroquinolones e.g. Ciprofloxacin 500mg, oral 12 hourly for 10 to 14 days, Levofloxacin 500mg, oral or IV once daily for 14 days, Moxifloxacin 400mg, oral or IV once daily for 14 days
- Azithromycin 1g, oral on day 1 and then 500mg once daily for 6 days
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