What is typhoid fever, how is it manifested, diagnosed and treated?

Infectious disease specialist

Sinitsyn

Olga Valentinovna

34 years of experience

Highest qualification category of infectious disease doctor

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With the onset of hot weather, the risk of contracting typhoid fever increases. This severe infectious disease is most common in tropical and subtropical countries, especially with poor water supply and low levels of sanitation. In Russia, isolated cases of infection are recorded annually, localized mainly in the southern regions.

General information about the disease

The causative agent of typhoid fever is the bacterium Salmonella typhi. The infection is transmitted from person to person through water, food or contact with contaminated surfaces. With strict adherence to personal hygiene rules, the risk of infection is minimized.

The infection affects the lymphatic system and digestive tract, spreading throughout the body through blood and lymph. Thanks to the presence of flagella, the bacterium actively moves within the intestine and penetrates through its walls into the blood vessels.

Typhoid bacillus can persist outside the human body for a long time. It does not encapsulate and does not leave spores, but when exposed to an unfavorable environment, it transforms into the cell-free L-form, which increases the resistance of the microorganism to drugs. However, it quickly dies when boiled and upon contact with antiseptics - alcohol, chlorine-containing substances and alkalis. At low temperatures, the bacterium can remain viable for several months.

How does infection occur?

The main cause of typhoid fever is the penetration of infection into the human body through the oral cavity. Most often this happens when:

• drinking unboiled water containing the bacteria Salmonella typhi;
• swimming in a contaminated body of water;
• consumption of food products containing pathogenic bacteria - milk and dairy products, jelly, poorly fried minced meat, unwashed vegetables and fruits;
• contact with surfaces on which particles of saliva, urine or feces of an infected person remain.

Sometimes the infection is transmitted by flies, which on their legs transfer bacteria from the patient’s feces to food. There are known cases of mother infecting a child through breast milk. The source of infection is always a person - a patient in the acute phase, during an exacerbation, or a carrier of the bacteria. The release of bacteria into the external environment begins already on the seventh day after infection.

How to recognize an infection

The course of the disease includes four periods, each of which has its own characteristic features. Symptoms of typhoid fever are different for each phase of the disease.

1. Incubation phase. It is characterized by a gradual increase in symptoms, which is expressed in general weakness, a gradual increase in temperature from physiological to 40 ° C, chills, headache, loose stools, decreased blood pressure and slowed pulse. At this stage, the signs of typhoid fever can easily be confused with influenza and other respiratory infections. A characteristic feature is a white coated tongue with teeth marks along the edges. The duration of the initial stage is 1-2 weeks.
2. Acute phase. The temperature reaches a maximum and fluctuates in waves throughout the day or remains unchanged. Toxins from dying bacteria affect the nervous system, causing severe headaches, insomnia and lethargy. A characteristic red rash appears on the skin of the abdomen, sides and back. Inflammation of the intestinal tissue causes severe pain in the patient. This period lasts about 1.5-2 weeks.
3. Resolution of the disease. The patient feels some relief: the temperature drops slightly, headaches decrease, sleep normalizes, and appetite appears. The improvement in well-being is explained by a decrease in intoxication of the body. The resolution period lasts about a week, after which a short-term return of the acute phase is possible.
4. Recovery. Within about 2 weeks, the patient feels weak, inflammatory processes decrease, and the functions of the affected internal organs are restored.

Due to the widespread use of antibiotics, the clinical picture is often blurred and insignificant. Early diagnosis of typhoid fever is most complicated, since the incubation period in many patients is asymptomatic. In approximately 2/3 of cases, exacerbation occurs suddenly or with a very short prodromal period.

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Typhoid fever

Ulcer

Vomit

Diarrhea

18398 January 21

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Typhoid fever: causes, symptoms, diagnosis and treatment methods.

Definition

Typhoid fever is an acute infectious disease manifested by fever and symptoms of intoxication.
Its causative agents are the bacteria Salmonella Typhi
, which are found in water, meat and dairy products. In the human body, bacteria begin to secrete endotoxin, which causes symptoms of the disease.

Bacteria are extremely resistant to unfavorable environmental factors and sudden temperature changes, but they die when boiled.
Causes of typhoid fever
Sources of infection are most often sick people or carriers of bacteria.

The transmission mechanism is fecal-oral, the pathogen is released into the environment with urine and feces; often the bacteria remain on poorly washed hands and enter the mouth through food.

Rarely and mainly among children, the disease can spread through contact and household contact - through dishes and hygiene items. A significant role in the spread of typhoid fever is played by flies, which carry microparticles of feces on their legs, so the peak incidence occurs in the summer-autumn period.

Typhoid fever is found everywhere, but it is most common in countries with poor sanitation and hygiene, in overpopulated cities with no access to clean drinking water.

Classification of the disease

There are three forms of the disease:

1. Typical course. It is characterized by a slowly increasing fever, severe symptoms of intoxication, and typical lesions of the gastrointestinal tract and skin.
2. Atypical course:

• erased form (the disease is milder, fever may be absent, symptoms of damage to the gastrointestinal tract are mild);
• asymptomatic form (there are no symptoms at all, but specific antibodies are detected in the blood);
• carriage of Salmonella Typhi
  .

1. Rare forms (pneumotyphoid, meningotif, nephrotyphoid, colotyphoid, appendicotyphoid, cholangiotyphoid, typhoid gastroenteritis).

The typical form of typhoid fever varies in severity:
mild, moderate and severe.

According to the nature of the flow, they are distinguished:

1. Cyclic typhoid fever (the most common variant) is characterized by cyclical pathological changes in the intestines for an average of 6 weeks. The cycle goes through stages from the gradual formation of ulcers on the intestinal mucosa to their complete healing and recovery of the patient.
2. Recurrent typhoid fever (occurs in 10–15% of cases) - characterized by the resumption of symptoms after a period of normalization of temperature for at least 14 days. On average, up to 5 relapses are observed, but they are milder than the first manifestation of the disease.

Based on the presence of complications, a distinction is made between
complicated and uncomplicated typhoid fever.

Symptoms of typhoid fever

Symptoms of typhoid fever usually develop 1-2 weeks after a person becomes infected with Salmonella typhi

.

In the typical course of the disease, there is an initial period that lasts about a week and is characterized by daily increasing fever (body temperature up to 40–40.5 ° C) and symptoms of intoxication.

Symptoms of intoxication include headache, weakness and fatigue, muscle pain, sweating, loss of appetite and weight, and sleep disturbances.

In some cases, there is a decrease in blood pressure, a dry cough, pain in the lower abdomen and constipation.

At the height of the disease, patients complain of lethargy, drowsiness, and stupor. Characteristic symptoms are pale skin and puffiness of the face.

Damage to the gastrointestinal tract is manifested by a white coating and swelling of the tongue. There is a characteristic rumbling, pain, bloating in the abdomen, the stool becomes liquid and greenish.

On the 8th–10th day of illness, a reddish rash appears on the skin of the chest, abdomen, and less often on the extremities.

The acute stage of the disease lasts about 1–2 weeks.

During the recovery period, the patient's appetite returns and sleep normalizes. However, pronounced weakness and emotional instability remain. Low-grade body temperature (not higher than 37.5°C) may persist for a long time.

Diagnosis of typhoid fever

Establishing a diagnosis begins with examining the patient, collecting complaints, medical history, mandatory recording of previous trips, contacts with sick people, and consumption of contaminated food.

To confirm the diagnosis, the doctor will prescribe laboratory and instrumental examination methods:

• Clinical blood test with a detailed leukocyte formula (helps to identify inflammatory changes).

Diagnosis methods

The most reliable methods for diagnosing typhoid fever today are laboratory tests.

1. Agglutination reaction to detect antibodies to the Salmonella typhi antigen. This test is carried out two weeks after infection. Its disadvantage is the possibility of a false positive result if another Salmonella bacterium is present in the body.
2. Indirect hemagglutination. The test can detect typhoid fever during the first week of illness.
3. ELISA. This method is highly accurate and allows you to determine the presence of any antibodies to bacterial antigens. Its advantage is the ability to conduct the test at all stages of the disease, including during the recovery period.

For general clinical and bacteriological studies, samples of the patient’s blood, feces and urine are taken. During the last phase of the disease, duodenal intubation is performed, during which a sample of the contents of the duodenum is taken.

Diagnostics

Photo: lebzdrav.ru

The main causative agent of typhoid fever is Salmonella. The bacterium enters the human body through the mouth. The microbe then passes through the large intestine and lymph nodes. It is at this stage that bacteria multiply and enter the circulatory system. In this regard, intoxication syndrome develops.

Diagnosis of typhoid fever: external signs

External indicators are very important when identifying typhoid fever. At the initial stage (duration of the disease is 3-5 days), the patient’s body temperature will reach the highest levels. The face is swollen, the skin is dry, bluish, and roseola-shaped pimples may appear in the chest area.

The patient's tongue is swollen and dry, covered at the base with a blue-gray film, and tooth marks may be found along the edges. The abdomen is swollen, there is rumbling and pain. Testing for typhoid fever in the first 2 days shows a normal white blood cell count. At the last stage of the disease, lymphocytosis, leukopenia, a significant increase in ESR and neutropenia are detected.

Diagnosis using laboratory tests

The most reliable method for detecting the disease is to determine the amount of Salmonella blood culture isolated. Early diagnosis allows one to obtain positive results throughout the entire period of the patient's febrile state.

A typhoid fever test should be performed daily for 3 days. It is recommended to carry out examination on the 1st day before taking antimicrobial drugs. Blood for typhoid fever is taken from the patient in the amount of 5-10 ml per 100 ml of bile-containing medium. For diagnostic purposes, tests are carried out until the patient’s temperature returns to normal. Pus, sputum, exudate fluid, and feces are also subject to examination. They are usually taken for analysis in the 2nd or 3rd week from the onset of the disease. Studies can be repeated if necessary every 5-7 days.

It is worth saying that the bacterial bacillus that caused the disease can be found in the urine and feces not only of a patient with typhoid fever, but also of bacteria carriers during any febrile conditions.

Serological testing for typhoid fever is also of great importance in diagnosis. Research is carried out 7-10 days from the onset of the disease. Serodiagnosis of typhoid fever is aimed at identifying the accumulation of O-antibody titers.

Thus, a positive response with type Vi antigen indicates prolonged carriage of the pathogen. A positive reaction to typhoid fever with the H-antigen indicates that the patient had suffered the disease previously or had been vaccinated. Recently, the disease is increasingly diagnosed using ELISA.

Testing for typhoid fever is carried out by taking stool and bile samples. In this case, diagnosis is aimed at identifying typhoparatyphoid carriage.

Remember: only a doctor should make a diagnosis, since many signs of the abdominal type correspond to symptoms of other diseases. Self-diagnosis (and especially treatment) can lead to irreversible consequences.

Specific prevention of the abdominal type consists of mandatory vaccination enriched with the Vi antigen. Vaccination is carried out for adults and children under 7 years of age. Mandatory and graded vaccination against typhoid fever is carried out for children under 15 years of age and adults.

As for nonspecific prevention, in this case general sanitary measures should be carried out aimed at combating flies (frequent carriers of bacteria), improving the quality of water supply and sanitary cleaning of populated areas, etc.

How to cure

Since the infection is extremely virulent, and the disease is severe and often complicated, treatment of typhoid fever must be carried out in the infectious diseases department of the hospital, in conditions of complete isolation. During illness, the patient remains in bed and does not leave the infectious disease ward. Therapy continues until the patient's body temperature returns to normal for ten consecutive days and includes:

• taking antibiotics (orally or by injection);
• replacement of fluid losses (orally or intravenously);
• a gentle diet with a high content of protein products;
• in case of intestinal perforation - surgical removal of a section of intestine with multiple injuries or closure of a single perforation with drainage of the peritoneum.

Taking antibacterial drugs continues for several months. Constant monitoring of patients' condition allows for timely detection of complications and prevention of their development. After discharge from the hospital, the patient is monitored at the dispensary for a certain time.

Medicines

Photo: farmacistiallavoro.it

Treatment of typhoid fever is complex, aimed at fighting infection, eliminating intoxication and dehydration, and preventing complications. Antimicrobial therapy is carried out using antibiotics and sulfonamides. Medicines are prescribed in tablets; in case of frequent vomiting, they are administered parenterally. The duration of the course is usually 7-10 days.

Sorbents are used to remove toxins from the intestines. In severe cases and severe intoxication, intravenous infusions of colloid and crystalloid solutions are indicated. In case of disturbances in the functioning of various organs and systems, appropriate symptomatic remedies are prescribed: sedatives, drugs to improve heart function, vitamin complexes, etc. To normalize the microflora after antibiotic therapy, probiotics and prebiotics are used.