Typhoid fever: how to recognise it, diagnose it and treat it in time?

How is typhoid fever caught?

The bacterium is shed in the stools of people who are ill or who carry it. Infection occurs by drinking water or eating food that has been contaminated: untreated water, ice, raw vegetables washed in contaminated water, food prepared with poorly washed hands. Humans are the only reservoir of the disease.

Symptoms usually appear one to three weeks after infection. Some people who have recovered continue to harbour the bacterium, often in the gallbladder, and can pass it on without being ill: they are chronic carriers.

Paratyphoid fever, caused by a closely related bacterium, produces a similar picture and is managed in the same way.

What signs should suggest typhoid fever?

The first few days

The fever sets in gradually and rises a little more each day. It comes with severe fatigue, headaches, loss of appetite and abdominal pain. Constipation is common in adults; diarrhoea is more common in children.

As the disease progresses

Without treatment, the fever becomes high and persistent. The patient may be listless, sometimes confused. The doctor may find a tender abdomen, an enlarged liver or spleen, and sometimes small pink spots on the trunk.

Emergency signs

Sudden, severe abdominal pain, a rigid abdomen, repeated vomiting, blood in the stools, confusion or drowsiness, or a fall in blood pressure call for emergency care. These complications mainly occur from the second or third week of untreated illness.

Typhoid or malaria: why a proper diagnosis is essential

In endemic areas, a fever is often treated straight away as malaria. Yet the two diseases can look alike, and sometimes occur together. A rapid diagnostic test or a thick blood smear can confirm or rule out malaria; if it is negative and the fever persists, other causes must be looked for, including typhoid fever.

Blood cultures, the reference test

The diagnosis relies on finding the bacterium in the blood, through blood cultures taken preferably before any antibiotic. They also allow an antibiogram, which shows which antibiotics are effective. Culture of the stools or, more rarely, of the bone marrow can complete the work-up.

The limits of the Widal test

The Widal test looks for antibodies in the blood. In regions where typhoid fever is common, many people have antibodies without being ill, and the test can also be falsely negative early on. Used on its own, it leads to many wrong diagnoses and to unnecessary antibiotic treatment, while the real cause of the fever goes unexplored. The rapid tests available also have limited performance.

Other tests

A blood test, liver and kidney tests, and an ultrasound or CT scan of the abdomen in case of pain or suspected complications help the doctor assess severity.

How is typhoid fever treated?

A suitable antibiotic, prescribed by a doctor

Treatment relies on an antibiotic, chosen by the doctor according to severity, age, any pregnancy and the resistance of bacteria in the region. Resistance of Salmonella Typhi to several older antibiotics is common, and it is increasing for other families. This is why self-medication and treatments stopped too early are dangerous: they encourage resistance and relapse. The result of the blood culture and antibiogram allows the treatment to be adjusted.

Severe forms

Typhoid fever with signs of severity is treated in hospital: intravenous antibiotics, rehydration, close monitoring and, if needed, intensive care.

Intestinal perforation, a surgical emergency

The bacterium can cause ulcers in the intestine, which may bleed or perforate. A perforation causes peritonitis and requires emergency surgery, combined with antibiotics and intensive care.

After recovery

The fever usually falls within a few days of suitable treatment, but fatigue can last. A relapse is possible: a fever that returns after recovery should prompt another medical visit. For people who handle food, stool tests may be requested to make sure they are no longer carriers.

How to protect yourself?

Water and hygiene

• Drink safe water: sealed bottled water, boiled or treated water.
• Wash your hands with soap before eating, before preparing meals and after using the toilet.
• Choose food that is well cooked and served hot, and peel fruit yourself.
• Avoid ice, raw vegetables and juices of uncertain preparation.

Vaccination

Vaccines against typhoid fever exist. The conjugate vaccine, recommended by the World Health Organization in countries where the disease is common, can be given from the age of six months, and several African countries have introduced it into their programmes. The vaccine protects well but not completely: hygiene measures remain essential. It does not protect against paratyphoid fever.

Frequently asked questions