A.

Definition
Typhoid fever is an acute disease associated with enteric fever characterized by
systemic disease accompanied by abdominal pain and fever with a "step-ladder" pattern
caused by the bacterium Salmonella enterica serotype Typhi. Other serotypes,
Salmonella paratyphi (A, B, C), also cause similar syndromes but with less clinically
significant disease. Fever characteristically comes in a step-wise pattern (i.e., rises
and falls alternatively) followed by headache and abdominal pain. Salmonella is said
to spread by the 'four Fs" (flies, fingers, feces, fomites).

B. Caused
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in
developed countries. It is still a serious health threat in the developing world,
especially for children.

C. Signs & symptoms

a. Fever
b. Headache
c. Weakness and fatigue
d. Stomach pain
e. Diarrhea or constipation
f. General aches and pains
g. Vomiting
h. Swollen stomach
i. Dry cough
j. Loss of appetite and weight loss
k. Rash

D. Treatments (medical & non-medical)

a. Medical treatments
 Antibiotic therapy is the mainstay of treatment. The treatment has been
complicated by multidrug resistance strains developed in many endemic areas,
especially in India and south-east Asia. The modality of treatment depends upon the
severity of the disease, duration, dissemination, and complications.
a) Antibiotic therapy
Prompt administration of the relevant antibiotic therapy protects from severe
complications of typhoid fever. Initial drug therapy of choice depends upon the
susceptibility of the strains. In most areas, fluoroquinolones are the most
effective drug of choice. In severe conditions that necessitate prompt treatment,
fluoroquinolones can be administered empirically on clinical suspicion before the
result of the diagnostic culture test. Fluoroquinolones cure about 98% of cases
with relapse and fecal carriage rates of less than 2%. Ciprofloxacin (500 mg
orally twice daily for 5-7 days) is the most effective fluoroquinolone.
Amoxicillin (750mg orally 4 times daily for about 2 weeks), trimethoprim-
sulfamethoxazole (160 mg twice daily for 2 weeks), and outside of the United
States, chloramphenicol (500mg 4 times daily for 2-3 weeks) are all alternative
treatments for adults in fully susceptible cases, but they are increasingly met with
resistance. Uncomplicated cases can be managed at home with oral antibiotics
and antipyretics. Patients with significant complications, including vomiting,
diarrhea, and abdominal distension, should be hospitalized. Additional supportive
therapy and parenteral antibiotics such as third-generation cephalosporins
(guided by culture sensitivities) should be continued until 5 days after recovery.
Multidrug-resistant (MDR) and extremely drug-resistant (XDR) strains have
developed in endemic areas. The intracellular nature of bacteria safeguards
against the extracellular antibiotics. In MDR cases, third-generation
cephalosporins (ceftriaxone, cefotaxime, and oral cefixime 2g once daily for 2
weeks) and azithromycin are the optimal treatment with ciprofloxacin as an
alternative treatment. The failure rate of these therapies is nearly 5% to 10%,
with relapse rate rates of 3% to 6%. These agents clear fever within a week with
 a fecal carriage rate of less than 3%. The addition of azithromycin and cefixime
lowers the rate of failure and reduces the duration of hospitalization.
b) Vaccination prophylaxis
Typhoid burden has been reduced since the invention of Salmonella
typhi vaccination. The vaccine is recommended for those traveling to areas with
risk of exposure. In the United States, there are two types of licensed,
unconjugated vaccines. The intramuscular Vi capsular polysaccharide vaccine is
appropriate for those greater than two years old. It should be given 2 weeks or
more before travel, and a booster should be provided every two years. A live
attenuated oral vaccine (Ty21a strain of serotype Typhi) enhances immunity by
stimulating the production of endogenous antibodies. It is indicated for those
over 6 years old traveling to endemic areas or coming into close contact with
chronic carriers or infected patients. It is done with a regimen of 4 capsules taken
every other day with strict guidelines regarding the temperature of liquids used to
ingest the capsule and ingestion on an empty stomach. It should be completed at
least 1 week before exposure, and a booster is indicated every 5 years. As it is a
live vaccine, the oral vaccine is not appropriate for pregnant patients or those
with immunocompromised status. Though not licensed for this indication, the
oral Ty21a vaccine may offer some protection against Salmonella paratyphi B.
Both vaccines have similar efficacy at 50% to 80%, and travelers must practice
avoidance measures in addition to the vaccine.
The World Health Organization Strategic Advisory Group of Experts on
Immunization first recommended the use of typhoid conjugate vaccines (TCVs)
in typhoid-endemic countries in 2017. Intramuscular, single-dose TCVs for those
6 months and older are now registered in Nepal, India, Nigeria, and Cambodia
and under further investigation for additional use in endemic areas and at times
of outbreak. When used in an outbreak of extensively drug-resistant typhoid in
Pakistan in 2018, the TCV was found to be safe among children between 10
years and 6 months of age. TCVs are also preferred due to the potential for a
longer duration of immunity, safety in younger children, and the improved
 immunogenicity profile when compared to the Vi polysaccharide unconjugated
vaccine.
c) Miscellaneous treatment
Symptomatic and supportive care is essential. Maintaining adequate hydration
during diarrhea, as well as appropriate ventilation and oxygenation for
pulmonary complications, should be provided along with analgesics and
antipyretics as supportive care for metastatic complications. Corticosteroids have
been suggested for severe cases with encephalitis.
d) Surgery
When gallstones accompany a carrier state, cholecystectomy can be
curative. Surgical repair is indicated for complications, including peritonitis and
ileal perforation.
e) Prevention through sanitation
Epidemiological data reveals that typhoid is more prevalent in low and middle-
income countries, in areas with poor drinking water, and lack of sanitation. Safe
drinking water, sanitation, and avoidance of overcrowding contribute remarkably
to the reduction in the number of cases.

b. Non-Medical treatments
Non-medical treatments for thypoid fever; disclaimer this tips for generic
condition It is in no way a substitute for qualified medical opinion. Please seek
medical help for more information base your condition
a) Drink lots of fluids
Diseases like typhoid often lead to dehydration; therefore, the patient should at
all times keep themselves hydrated by drinking lots of fluids. The fluids can be
water, fresh fruit juices, herbal tea, etc.
b) Garlic
It contains antioxidants and acts as blood purifier. It helps the kidney flush out
unwanted substances from the body; thus, cleansing the system. It fosters the
healing process and boosts immunity of the person suffering from typhoid fever
c) Basil
Is a popular herb which eases inflammation and joint pains which are common
with home remedies for typhoid fever. The antibacterial properties of basil help
in removing the bacteria that causes typhoid
d) Apple cider vinegar
Apple cider vinegar has acidic. It brings high fever down as it draws out heat
from the body of the person suffering from typhoid. It contains minerals which
are extremely important for a person who is sick and is losing nutrients because
of diarrhea
e) Cold compress
A person down with typhoid suffers from high fever which stays for days;
therefore, it is very important to maintain a normal body temperature. This can
achieved with the help of a cold compress which is a cloth damp with cold water.
It is then put on the patient's forehead, armpits, feet and hands.

E. Prevention
The three most effective methods of preventing typhoid are: adherence to strict
hand washing with soap and water after using the toilet and before handling food; the
provision of safe water, and adequate sanitation. Patients with typhoid fever should
pay strict attention to hand hygiene and should not be involved in food preparation
until they have been shown to be free of infection.
The following recommendations will also help ensure the prevention of typhoid fever
:
 Ensure food is properly cooked and still hot when served.
 Avoid raw milk and products made from raw milk. Drink only pasteurized or
boiled milk.
 Avoid ice unless it is made from safe water.
 When the safety of drinking water is questionable, boil it or if this is not
possible, disinfect it with a reliable, slow-release disinfectant agent (usually
available at pharmacies).
  Wash fruits and vegetables carefully, particularly if they are eaten raw. If
possible, vegetables and fruits should be peeled.

REFERENCES

https://www.ncbi.nlm.nih.gov/books/NBK557513/
https://www.nicd.ac.za/assets/files/TyphoidFAQ_20170106.pdf
https://www.who.int/immunization/monitoring_surveillance/burden/vpd/WHO_Surve
illanceVaccinePreventable_21_Typhoid_BW_R1.pdf?ua=1
https://www.nhs.uk/conditions/typhoid-fever/causes/
https://www.cdc.gov/typhoid-fever/symptoms.html
https://doctor.ndtv.com/living-healthy/typhoid-5-best-home-remedies-1879094?
amp=1
https://www.who.int/news-room/fact-sheets/detail/typhoid