Typhoid Fever

TYPHOID FEVER

 

An acute illness associated with high grade fever if left untreated leads to potentially serious complications and possibly death.  It is common in parts of the world that have poor sanitation and limited access to clean water. It is caused by Salmonella Typhi bacteria. It is spread via ingestion of contaminated food and water.

 

Symptoms usually begin after one week to a month post exposure.  The most common symptom is high grade fever, a temperature of about 104F. 

 

Other symptoms are:

  • Weakness
  • Abdominal pain
  • Constipation
  • Headaches
  • Diarrhea
  • Vomiting
  • Rash, rose colored spots on the neck and abdomen.

 

Typhoid is diagnosed by detecting the presence of Salmonella Typhi via blood, stool, urine, or bone marrow sample culture.

 

 

The only effective treatment is by antibiotics sensitive to the bacteria. With the overuse of antibiotics the bacteria has developed strains which were initially treated by first line drugs are no longer responding to it (multi drug resistant Typhoid fever) and have developed some strains that are resistant to all recommended antibiotics for typhoid fever (extensive Drug Resistant Typhoid Fever). These are stated in Table 1[1]

 


 

 

 

Table 1. Classification of Typhoid Fever Cases by Drug Resistance Status, Pakistan, 2018

 

From 1 November 2016 through 9 December 2018, 5 274 cases of XDR typhoid out of 8 188 typhoid fever cases were reported by the Provincial Disease Surveillance and Response Unit (PDSRU) in Sindh province, Pakistan. Sixty-nine percent of cases were reported in Karachi (the capital city), 27% in Hyderabad district, and 4% in other districts in the province.

 

Prevention is via clean water, sanitation and repeated hand washing. Vaccine for non resistant typhoid is available and given to everyone over the age of two years.  With the outbreak of Extensive Drug Resistant Typhoid, a new vaccine for it was available for the school going children in Pakistan funded by Bill and Melinda Gates Foundation. 

 

A 16 year old male patient came to my clinic with complains of high grade fever and abdominal pain for the past 3 days, Upon examination he had 103F fever and abdominal pain. After a basic blood workup and culture test the results pointed towards a bacterial infection . I started the patient on IV Rocephin which is a third generation cephalosporin with a probable diagnosis of non resistant typhoid fever. However the fever was not responding and started vomiting as well. Once the culture report came the reports showed that he was suffering from Salmonella typhi which was sensitive to Imipenem ( IV antibiotic) and Azithromycin. Hence, I realized why IV Rocephin was not working on the drug resistant typhoid fever. I started the patient on oral Azithromycin which he tolerated and the fever subsided, I gave him for a total 14 days. Treating patients with the growing incidence of extensive drug resistant typhoid, I realized that patients overuse antibiotics without prescription, or fail to complete their course. I suggest patients should not start antibiotics without a doctor's prescription and should get blood cultures before starting any medicine as it can deviate or skew the blood works results. The antibiotics for each of the three types of typhoid hence it is suggested to get blood tests and cultures for an accurate diagnosis. Without proper diagnosis only further complications can arise. 

 [1] WHO World Health Organization.