Typhoid - মায়া


Short history of Typhoid-  How Typhoid came into our life?
“Mary Mallon” – known as Typhoid Mary, was the first lady in the United States to be  identified as a career of the bacteria responsible for typhoid fever without having symptoms related to the condition. She was a cook and throughout her career around 51 people got infected from her. She was isolated once in  1907 and in 1915 for observation and died at the age of 69.
What is Typhoid Fever?  
Typhoid fever is also known as enteric fever . It is  an acute infection caused by bacteria. It is contagious and can damage multiple system inside us by affecting whole body .  
Is it life threatening ?

  • If remains undiagnosed  and  left untreated, this infection can have life threatening consequences.  

Causative bacteria  

  • Mostly caused by  Salmonella typhi.
  • Can also be caused by Salmonella Paratyphi usually leads to severe illness.

How do people get Typhoid Fever ?
Drinking and eating contaminated  water and food  with this bacteria  leads to Typhoid fever. It is transmitted by fecal-oral route.
Persons with typhoid fever carries Salmonella Typhi (lives only in human)  in their blood and intestine. Even small number of people those recovered after  treatment with antibiotic may continue to carry the bacteria in their body (intestine, gallbladder)   and are known as carriers.  
Both ill person and carriers can contaminate surrounding water supply through stool which contain high amount of bacteria.  
If you eat food or drink beverage handled by an ill person or carrier or if contaminated water is used for  drinking or washing food, you can get infected. Therefore, it is more common in developing countries like our Bangladesh where hand washing is less frequent and water is likely to be contaminated with sewage system.  
In Bangladesh more chances are in rural areas, as ponds and river water is  used for bathing, cooking and  daily use of household works.
In developed countries, people  may get infected during travelling and spread it to others.  
How will you know if you have Typhoid ?
Symptoms are likely to develop gradually and in few may even appear lately as the bacteria multiplies in our body in 10-14  days which sometimes ranges from 3 to  21 days.
Symptoms can appear weeks wise. Early illness symptoms  are-  
First Week-

  • Fever -starts  low and increases daily, possibly reaching as  104.9 deg.F (known as  step ladder pattern)
  • Headache   
  • Rash
  • Dry cough
  • Muscle Pain
  • Constipation.

Second week-

  • Fever –Constant
  • Diarrhoea
  • Swollen abdomen ( increase in size of spleen and liver)  
  • Abdominal pain
  • Rash resolved and appearance of rose like spots on the skin.
  • Loss of appetite, weight loss

Third / Fourth week-
If remain untreated then any complications- such as infection  of intestine leading to severe bleeding, infection of liver, spleen, gallbladder, brain- may lead to life threatening condition where ill person will lie motionless and exhausted with eyes half closed known as typhoid state. This May eventually lead to even coma and death.
Who are at risk of developing Typhoid fever ?
Typhoid  fever remains a serious threat especially in developing countries. Children are at  greatest risk of getting the disease. They generally have milder symptoms than adults do.
People who may get infected easily are those  –  

  • Have close contacts with someone who is infected or has recently been infected.
  • Drinking or using  contaminated sewage water with the bacteria.  
  • Work in or traveling to areas where typhoid fever is common.  
  • Work as a clinical microbiologist handling bacteria in laboratory.  

What are investigations done for diagnosis?  

  • Blood culture – at least two samples are taken, sensitivity is 90%  in 1st week, decreases to 50% by 3rd week.
  • Stool culture – 2nd week
  • Complete blood count- increase in white blood cell (leucocytes) count.
  • Widal test- done in 2nd week ,specific test for typhoid fever.

Usually done  during 2nd week or after there will be 4 fold rise in antibody titers.  

  • Bone marrow culture- done in selected cases when remains positive despite of ≤ 5 days of antibiotic therapy.

How you are diagnosed?
Brief medical history including symptoms, travelling area, recent medication and vitamins taken, past history of typhoid fever and along with blood and stool culture report the final confirmatory diagnosis is done .   
Treatment for typhoid fever
Choice of antibiotic is guided depending on geographic  region where infection  was contracted.

  • In our country- oral Cap. Ofloxacin (400mg)  or Ciprofloxacin (500mg) given twice daily for 10 days.  
  • In severe case- hospital  admission and intravenous fluid and antibiotic is given and maintained intravenously (IV).  Sometimes high doses of amoxicillin may be chosen depending on patient’s   condition.

Along  with medication,  drinking lot of fluid  or IV fluid therapy helps to improve . In complicated cases surgery may be required for removal of affected organ. You  may remain feverish up to 5 days after starting antibiotic. So, in that case do not be afraid, have patience.  
Can you prevent typhoid ?  
The good news is , yes it is a preventable disease.  
You can prevent it in two ways-

  • Maintenance of proper hygiene such as frequent hand washing before and after having meal   
  • Avoid vendor foods and drinks
  • Avoid raw vegetables and fruits that cannot be peeled
  • Choose hot food
  • Drink boiled or purified water
  • Use clean water for day to day works  

Get Vaccinated-
Two types of vaccination  are available.

  • Ty 21 an oral vaccine given on days 1,3,5 and 7 with a booster every 5 years
  • Vi CPS – Parental vaccine given in 1 dose with a booster every 2 years-Preferred for travelers.  


Vaccine Name How Given Number of Doses Necessary Time between Doses Time immunization should be completed by  (before possible exposure)   Minimum Age for vaccination Booster Needed every
Ty 21a 1 Capsule  by mouth 4 2 days 1 week 6 years 5 years
Vi CPS Injection 1 N/A 2 weeks 2 years 2  years

In Bangladesh available preparations are-  

Name Marketer Form Price
Typherix Glaxosmithkline Injection 394 Tk.
Typhim VI Sanofi 444.17 Tk.
Vaxphoid Incepta Pharmaceutical  Limited. 300 Tk.

You can get it from Apollo hospital, IBN Sina hospital vaccination centre.
www. applodhaka.com/vaccination/- click on this for further information regarding phone number and appointment.
Photosource – TT.jpg

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