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Typhoid fever, Causes, Diagnosis, Treatment, Prevention, Complications

 

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Typhoid fever, Causes, Diagnosis, Treatment, Prevention, Complications

Typhoid fever is an infectious disease caused by the bacterium Salmonella typhi. This infectious disease is generally transmitted through food or drink contaminated with the patient's feces or urine. If not handled properly, this disease can cause complications that are fatal.

Typhoid fever or typhus occurs a lot in Asian countries, including Indonesia. In Indonesia, typhoid fever is classified as an endemic disease. It is estimated that 500 out of every 100,000 Indonesian people get typhoid fever every year.

Although both are caused by Salmonella bacteria, typhoid fever is different from Salmonella infection (salmonellosis). Salmonellosis is caused by Salmonella bacteria, while typhoid fever is caused by a type of Salmonella bacteria, namely Salmonella typhi.

Typhoid fever or typhus is also different from typhus or typhus. Typhus is caused by Rickettsia and Orientia bacteria.

Causes of Typhoid Fever


Typhoid fever is caused by the bacterium Salmonella typhi. These bacteria can enter and develop in the intestine after a person consumes food or drink contaminated with feces or urine of a patient with typhoid fever.

Salmonella typhi can also be transmitted from patients who are asymptomatic but still carry the bacteria. This happens because the healing has not been done completely so that Salmonella typhi is still left in the intestine and can be transmitted to other people.

Risk factors for typhoid fever

Although typhoid fever is more common in children, there are a number of other factors that can increase a person's risk of developing typhoid fever, namely:

  • Visiting or working in an area with a high incidence of typhoid fever
  • Make direct contact with typhoid fever sufferers
  • Living in a dirty and unsanitary environment
  • Working as a health worker who treats patients with typhoid fever
  • Eating vegetables or fruits that are not washed clean
  • Using the same toilet as the sufferer and not washing hands afterwards
  • Eating seafood from water contaminated with bacteria
  • Having sex through the mouth (oral sex) with typhoid fever sufferers

Symptoms of Typhoid Fever


Symptoms of typhoid fever appear 7-14 days after a person is infected with the bacterium Salmonella typhi. How long symptoms last depends on the progression of the disease.

Typhoid fever sufferers may experience initial symptoms in the form of:

  • Fever that increases gradually until it reaches 39–40°C
  • Headache
  • Muscle ache
  • Tired and limp
  • Excessive sweating
  • Dry cough
  • Loss of appetite
  • Weight loss
  • Stomach ache
  • Constipation
  • Red rash on the skin
  • Swelling in the abdomen


If the disease gets worse, typhoid fever can cause further symptoms, such as:

  • Dazed or delirious
  • Hallucinations
  • Diarrhea
  • shivers
  • The body feels very tired
  • Difficulty concentrating
  • Bloody stools

When to see a doctor

Immediately see a doctor if you experience the symptoms mentioned above, especially if you have just traveled to an area with a high case of spreading typhoid fever. It should be noted that people who have received the typhoid vaccine are still at risk of developing typhoid fever.

Even though the symptoms of typhoid fever are almost the same as the symptoms of other infections, you should still see a doctor. Early examination is needed to confirm the condition and prevent the risk of complications.

Diagnosis of Typhoid Fever


The doctor will ask questions and answers about the symptoms, as well as the patient's medical history and travel. After that, the doctor will carry out a physical examination by measuring body temperature, looking for reddish rashes on the skin, and pressing on the stomach to check for swelling in the liver or spleen.

To confirm the diagnosis, the doctor will carry out a number of further tests, namely:

  • Blood, urine and stool tests, to detect the presence of Salmonella typhi bacteria
  • Bone marrow aspiration, to further confirm the presence of Salmonella typhi bacteria from the results of blood, urine and stool tests, but this test is rarely done
  • Widal test, to detect antibodies against Salmonella typhi bacteria
  • TUBEX TF test, to detect antibodies against Salmonella typhi bacteria with a higher sensitivity than the Widal test


It should be noted that in areas where typhoid fever is endemic, such as Indonesia, almost all residents have been exposed to Salmonella typhi bacteria. This makes the body naturally form antibodies against these bacteria.

Considering that the Widal test works by detecting antibodies to the Salmonella typhi bacteria, this test can give a positive result even if the patient does not have typhoid fever. Therefore, in determining test results, doctors will be more careful to get an accurate diagnosis.

Treatment of Typhoid Fever

Typhoid fever treatment is carried out depending on the severity. If typhoid fever is detected early and only causes mild symptoms, the patient can carry out independent treatment at home. Generally, doctors will give the following medicines:

  • Antibiotics, such as ciprofloxacin, ceftriaxone, and azithromycin, for bacterial infections, which must be taken for 2−3 weeks
  • Fever-reducing drugs, such as paracetamol


Unfortunately, many Salmonella typhi bacteria are resistant to the antibiotics chloramphenicol, ampicillin, and co-trimoxazole. Therefore, antibiotic drugs must be prescribed by a doctor and taken by the patient completely, and evaluated by a doctor.

Meanwhile, in cases with severe symptoms, patients need to be hospitalized. The doctor will give antibiotics by injection and intravenous fluids to prevent dehydration. If needed, the doctor can also perform surgery, especially if the patient has bleeding or tears in the digestive tract.

During the treatment period, patients are also advised to do the following things to speed up the healing process:

  • Don't do strenuous activities
  • Get enough rest
  • Eat small portions, but often
  • Eat soft, non-spicy foods if you can't eat solid food
  • Wash hands with soap and running water regularly
  • Drink enough water

Typhoid Fever Complications


If you don't get proper treatment, typhoid fever can cause several complications. Some of the most common complications are:

  • Bleeding in the digestive tract requiring blood transfusions
  • Tears in the digestive tract, which can develop into peritonitis and be fatal


Apart from the complications above, there are several other complications that can arise, namely:

  • Inflammation in the heart muscle (myocarditis)
  • Bladder infection
  • Kidney failure
  • Inflammation of the inner lining of the heart (endocarditis)
  • Meningitis
  • Vascular infection
  • Pneumonia
  • Pancreatitis

Prevention of Typhoid Fever


One effort to prevent typhoid fever is to get a typhoid vaccine. This vaccine is included in the immunization program recommended by the government. Although generally given to children aged 2–12 years, the typhoid vaccine can also be given to adults who are at risk of developing typhoid fever.

Apart from vaccines, there are several other preventive measures that can be taken, namely:

  • Frequently wash hands with soap and running water
  • Avoid consuming raw fruits and vegetables that are not washed with clean water
  • Make sure the water to be drunk has been boiled until cooked
  • Avoid consuming raw or immature foods
  • Limit consumption of snacks and drinks sold on the roadside

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