Typhoid is a disease caused due to infection by the microbe called Salmonella typhi. Someone suffering from typhoid fever passes the germs along with his stool and this may gain entry in the body of a healthy person due to consumption of contaminated food or water. After entry in the body, it causes infection and inflammation of the small intestines.

Typhoid fever is a major international health threat regardless of age, race or background. The illness is manifested in the form of high fever which usually remains high unless treated actively. This is associated with either diarrhea or constipation and vomiting with abdominal pain. Due to the high fever itself, one can develop delirium (state of confusion) and convulsions. Release of toxins by the microbes in the blood stream can lead to septic shock which needs urgent intervention and resuscitation of the patient to prevent death. The coverings of the brain may get infected as the germs reach there through the blood stream and cause meningitis. Involvement of the brain stem can lead to encephalopathy due to which the patient becomes unconscious or comatosed.

Other complications usually develop after the 2nd to 3rd week of untreated infection.

In the 3rd week of illness, the patient may start passing blood or dark tar like stool due to internal bleeding from the intestines. This can cause shock and death. The intestine may get perforated and cause peritonitis which is manifested by severe diffuse abdominal pain, distension and board like stiffness of the abdomen. It is a potentially life threatening condition, unless promptly treated. Apart from this, germs of typhoid fever can spread to other parts of the body directly or via blood stream or lymphatics and cause many complications.

Involvement of the gall bladder leads to its inflammation. This is manifested by pain in the right upper abdomen and sense of bloating after meals. The pancreas can also be inflamed leading to abdominal pain. Rarely kidney or urinary bladder infections can also occur.

The infection can spread to any joint of the body causing it to become swollen and painful. Usually a big joint like knee or elbow is affected.

The airways of the lungs or lung tissue can get infected resulting in bronchitis or pneumonia. This causes cough which may be dry or associated with expectoration and fever. Even the heart is not spared. Two to four weeks after the initial infection, one may develop affection of the middle covering of the heart, which causes slowing of the heart rate and even irregular heartbeats. One feels dizzy and breathless at times due to this alteration of the regular heart beat.

Even after immediate recovery from the illness, the intestines remain vulnerable while they are inflamed. Excess load put on them in form of heavy meals can also induce discomfort and perforation. Therefore after recovery from typhoid fever, sometimes people are advised to avoid heavy physical exertion and take small frequent meals preferably free from fats or spices. This is said to help in healing of intestines.

Diagnosis of typhoid fever is through demonstration of the germs in culture. But in case of later complications it needs a high degree of suspicion to consider microbes of typhoid to be the cause for a pneumonia or myocarditis. After suspicion suitable samples are taken to demonstrate the germs by microscopic examination or culture in suitable body fluids. Treatment is by suitable antibiotics.

All these complications and botheration can be avoided by prevention of typhoid fever. This is possible by maintaining good personal and food hygiene. Ensuring that the food and water consumed is clean ensures that germs of typhoid do not enter the body.

Dr. Rachna Pande is a Specialist in internal medicine

E-mail-rachna212002@yahoo.co.uk