Typhoid fever: Description
Typhoid fever is a severe diarrheal disease caused by bacteria. Doctors distinguish between typhoid fever (typhus abdominalis) and typhoid-like disease (paratyphoid fever). Every year, about 22 million people worldwide contract typhoid fever; the number of deaths is estimated at 200,000 per year. Children between the ages of five and twelve are most commonly affected. Paratyphoid fever is estimated to cause 5.5 million cases per year.
Typhoid fever cases in Germany, Austria and Switzerland are usually introduced by travelers. In 2019, 86 typhoid and 36 paratyphoid cases were registered in Germany. In Austria, the total annual number of cases is less than ten, and in Switzerland between 20 and 50.
In all three countries, there is an obligation to report typhoid or paratyphoid fever.
Typhoid fever: symptoms
The following symptoms may occur in abdominal typhoid and paratyphoid fever:
Abdominal typhoid fever (typhus abdominalis).
It begins with nonspecific symptoms such as a general feeling of illness, headache and pain in the limbs, as well as abdominal pain and constipation. The body temperature rises slowly. If left untreated, a high fever of between 39°C and 41°C may develop within two to three days. The fever can last up to three weeks.
The full-blown typhoid fever (from the 3rd week of illness) is accompanied by an increase in general symptoms, cough and pea-pulp-like diarrhea. Muscle pain and (rarely) joint pain may be added.
Typhoid-like disease (paratyphoid).
Anyone who has survived a paratyphoid infection is immune for about a year. However, if affected individuals are exposed to a high dose of the pathogen, immunity can be lost again.
Typhoid fever: causes and risk factors
The causative agents of typhoid fever are salmonellae. Typhoid abdominalis is caused by the bacterium Salmonella enterica typhi and paratyphoid is caused by Salmonella enterica paratyphi. These bacteria are distributed worldwide.
The time between infection and the onset of the disease (incubation period) is about 3 to 60 days for typhoid abdominalis (usually eight to 14 days) and about one to 10 days for paratyphoid fever.
Typhoid fever: examinations and diagnosis
The diagnosis of typhoid fever begins with an interview to obtain the patient’s medical history. Particularly important information for the physician is, for example, travel to typhoid regions or longer stays abroad by the patient.
At the beginning, typhoid and paratyphoid fever are often mistaken for flu-like infections. In return travelers from the tropics, there is also a risk of confusion with malaria and other tropical diseases.
When the bone marrow is examined, typhoid or paratyphoid fever can be detected even after the disease has healed.
Typhoid fever: treatment
A major problem is that resistant germs are increasingly developing in typhoid areas, against which common antibiotics such as cotrimoxazole or amoxicillin are no longer effective. Experts therefore recommend testing the effectiveness of isolated pathogens before treatment.
In addition to antibiotic therapy, adequate fluid intake is also very important: patients with typhoid fever should drink plenty of fluids to compensate for water loss. The electrolyte balance (blood salts) must also be brought back into balance.
Hygiene is also advisable to prevent infection of contacts.
In typhoid patients with gallstones, the typhoid bacteria can settle in the gallbladder. In such cases, removal of the gallbladder must be considered.
Typhoid fever: course of the disease and prognosis
With early therapy with antibiotics, the prognosis for typhoid and paratyphoid fever is very good. Compensation for large fluid loss also contributes to rapid recovery. Mortality in treated patients is less than one percent.
In typhoid patients with gallstones, the typhoid bacteria can settle in the gallbladder. In such cases, removal of the gallbladder must be considered.
Typhoid fever: course of the disease and prognosis
With early therapy with antibiotics, the prognosis for typhoid and paratyphoid fever is very good. Compensation for large fluid loss also contributes to rapid recovery. Mortality in treated patients is less than one percent.
In addition, avoid raw or insufficiently heated food. This includes, for example, leaf and delicatessen salads, seafood, unpeeled fruit or juices – they could be contaminated with typhoid or paratyphoid pathogens. It’s best to heed the rule: “Peel it, cook it, or forget it!” – “Peel it, cook it, or forget it!”.
Typhoid vaccination
It is possible to be vaccinated against typhoid fever (typhus abdominalis) – but not against paratyphoid fever – which is particularly advisable before traveling to risk areas. On the one hand, an inactivated vaccine is available, which is administered as an injection (once only). This typhoid vaccine provides protection for about two to three years.
However, the following applies to both types of typhoid vaccination: they do not provide 100 percent protection against abdominal typhoid fever. Despite vaccination, you can still fall ill. However, the course of the typhoid fever is usually milder than without vaccination.
Read more about this topic in the article Typhoid vaccination.
