Typhoid fever

Typhoid fever is an illness caused by the bacterium Salmonella typhi. Common worldwide, it is transmitted by ingestion of food or water contaminated with feces from an infected person. The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.


Typhoid fever is also called enteric fever. It happens due to the involvement of the intestines and may become very serious if treatment is not provided to the patient at the right time. Typhoid fever has a tendency to relapse the patient. It is sometimes accompanied by hoarse cough and constipation or diarrhoea. Typhoid fever is mainly transmitted by ingestion of food or contaminated water from an infected person. Typhoid fever is still common in many developing countries like india, where it affects about 21.5 million persons each year.

Who gets typhoid fever?
Anyone can get typhoid fever if they drink water or eat food contaminated with the S. typhi bacteria. Travelers visiting developing countries are at greatest risk for getting typhoid fever. Typhoid fever is still common in the developing world, where it affects about 12.5 million persons each year. Only about 400 cases occur each year in the United States.

Typhoid fever is usually recognized by the sudden onset of sustained fever.
During typhoid fever you may also suffer from severe headaches.
Nausea is an another symptom for typhoid fever.
Some times Stomach Pain is also accounted.
Sometimes the person also suffers from severe loss of appetite.
Typhoid fever accompanied by insomnia and feverishness, particularly at night.
In the beginning the temperature of the body is slightly high in morning, then it gradually becomes normal in the afternoon and then again rises in the evening. The temperature of sustained fever may go up to as high as 103° to 104° F (39° to 40° C ).
They may also feel weak, or have gastroenteritis, headache, diarrhea and anorexia (loss of appetite). In some cases, patients have a rash of flat, rose-colored spots.

Classically, untreated typhoid fever course is divided in 4 weeks. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. Epistaxis is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week.

In the second week of the infection, the patient lies prostrated with high fever in plateau around 40ºC and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated and this delirium gave to typhoid the nickname of “nervous fever”. Rose spots appear in lower chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be felt. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea-soup. Howewer, constipation is also frequent. The spleen and liver are enlarged and tender and there is elevation of transaminases . The widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive in this stage. In the third week of the typhoid fever a number of complications can occur:

Intestinal haemorrhage due to bleeding in the congested Peyer patches; that can be very serious but generally does not lead to death.
Intestinal perforation in distal ileon: this is a very serious complication that is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
Toxic myocarditis with collapse
Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little around the day. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week defervescence commences that prolongs itself in the fourth week.

The ways typhoid fever spreads:

Typhoid fever appears to have affected thousands of human beings from last so many years, but the cause of the illness is a poisonous and interruptive bacterium called Salmonella typhi . Typhoid fever mainly spreads when people eat food or drink water which is already been infected with Salmonella typhi. This bacteria lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Therefore, typhoid fever is more common in unhygienic areas of the world where hand washing is less frequent and water is likely to be contaminated with germs. It also spreads through direct contact with a person who is already infected with this disease.

A different pathogen, Salmonella paratyphi , causes paratyphoid fever. Although they’re related, these aren’t the same bacteria responsible for salmonellosis, another serious intestinal infection.

After treatment, some people who recover from typhoid fever, even then continue to harbor the bacteria in their intestinal tract or gallbladder, for some years. These people are called chronic carriers, usually shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi.

Diagnosis is made by blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.

Typhoid fever in most cases is not fatal. However, in some cases it is. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa and Latin America). Typhim Vi is an intramuscular killed-bacteria vaccination and Vivotif is an oral live bacteria vaccination, both of which protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither protects against unrelated typhus.
Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone.

There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as “sensitive to ciprofloxacin”, but that isolates testing sensitive to CIP but not to NAL should be reported as “reduced sensitivity to ciprofloxacin”. However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method. It not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent disc testing and cannot test for MICs.

Ayurvedic Treatment for Typhoid fever
Given below course you may follow for general treatment of typhoid fever, it depends on subjective or objective symptoms of the patient.

In first week: You may take 125 mg each of Muktashukti Bhasma and Mrigshringa Bhasma, at least three times daily which should be mixed with honey. A decoction of 12 gm of Khub Kalan and 10 gm of dried grapes with one litre of water, boiled down to about one-third, can be given along with the above medicines.

In second week: You may take a dose of Muktashukti Bhasma (10-12mg) & a dose of Kasturibhairava Rasa (120-125mg) with honey thrice daily. You may also take a mixture of Saubhagya Vati (240 mg) and Jwararyabhra (120 mg) three times in a day with juice of fresh ginger.

In third week: Mix 120 mg of Pravala Bhasma and 120 mg of Vasantmalati Ras with atleast 120 mg Amritsattva, to be taken with honey at least two times in a day. After at least three hours of serving the above medication give a dose of 240 mg of Powder of Pippali & also 240 mg of sarvajwaralauha with honey atleast two times in a day.

That is first, second & third, second should be taken alternatively.

In fourth week:You may take a mixture of Navayasa Choorna (Powder) – 2.5 mg & Vasantmalati Ras 125 mg & Sitopladi Choorna – 1.5 gm (Two Doses) to be taken with honey at least two times in a day. After meals, take a liquid compound prepared from- 10ml of Amritarishta & 5ml of Vishmushtayasava with 10ml of Lauhasava (one dose to be taken for each with equal quantity of water after lunch & dinner meals).

If whole body is massaged with oil, preferably Mahalakhshadi Tail daily, it will provide much desired relief to the patient and also help in quicker recovery. Some people suggest massage with olive oil or Johnson’s Body oil but, then, it is simply a matter of individual response and suitability, availability and choice.

Now vaccines for typhoid fever are also available, but these vaccines are not effective so much and are just partially effective and are usually reserved for people who may be exposed to the disease or are traveling to areas where typhoid fever is endemic. No vaccine has been discovered till date for paratyphoid fever.

It is always adviced to follow the Tips (Specially in Typhoid prune area)

Avoid foods and drinks that you may think may be contaminated. Also avoid eating things that have been kept in the open for long time.

Most important thing – Get vaccinated against typhoid fever.

Use careful selection of food and drink while you are in a developing country. This will also help protect you from other illnesses such as cholera, dysentery and hepatitis A.
Only use clean water. Buy it bottled or make sure it has been brought to a rolling boil for at least one minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
Ask for drinks without ice unless the ice is made from bottled or boiled water.
Only eat foods that have been thoroughly cooked.
Avoid raw vegetables and fruits that cannot be peeled.
When you eat raw fruits or vegetables that can be peeled, wash your hands with soap, then peel them yourself. Do not eat the peelings.
Avoid foods and beverages from street vendors. Many travelers get sick from food bought from street vendors.
Even if your symptoms go away without treatment, you may still be carrying the S. typhi bacteria, and your illness could return and be passed to other people.
If you work at a job where you handle food or care for small children, you should not go back to work until a doctor has determined that you no longer carry any S.typhi bacteria.
Even if you are vaccinated, you should carefully select your food and drink, especially when visiting areas where typhoid fever is common.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Help taken from :Ayurvedic-medicines.com , en.wikipedia.org and http://health.utah.gov/epi/fact_sheets/typhoid.html

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