Typhoid fever

Disease Description (Causes and Symptoms)

• Definition: Typhoid fever is an acute systemic infection caused by Salmonella enterica serotype Typhi (Salmonella typhi). It is a fecal–oral transmission disease for which humans are the only host.
• Cause/Transmission: Infection occurs through contaminated food or water, or food contaminated by the hands or feces of an infected person (symptomatic person or carrier). Contaminated seafood, such as oysters and shellfish, may also be a cause.
• Pathophysiology: Bacteria entering through the intestinal tract pass through the intestinal mucosa and penetrate the mesenteric lymph nodes and bloodstream, causing systemic bacteremia. Erosion of lymphoid follicles (Peyer’s patches) in the intestinal mucosa, particularly the ileocecal region, may cause ulcers, perforation, and bleeding.
• Main symptoms: Fever (gradually rising to a high fever), headache, chills, weakness, abdominal pain, diarrhea or constipation (constipation in some patients), intestinal bleeding and peritonitis (in cases with complications), and red spots on the skin (rose spots) may be observed.
• Typical course: The incubation period is usually several days to several weeks (generally 6–30 days). Without treatment, symptoms may persist for several weeks and may progress to complications such as intestinal perforation and bleeding.

Treatment

• Principles: Appropriate antimicrobial treatment and supportive care (fluid and electrolyte replacement, nutritional management) are required. Surgical treatment may be necessary if complications occur. Infection control (isolation and hygiene) is essential.
• Antibiotics:
  • Recommended (depending on local susceptibility): Third-generation cephalosporins (e.g., ceftriaxone IV) or azithromycin (oral) are currently first-line options in many regions. IV treatment is necessary in severe cases.
  • Past/alternative medications: Use of chloramphenicol, ampicillin, and trimethoprim–sulfamethoxazole has decreased in some regions because of resistance issues. Fluoroquinolones (ciprofloxacin) are effective against susceptible strains, but resistance is increasing worldwide.
  • Treatment duration: Approximately 7–14 days for mild, uncomplicated cases; longer for severe cases or cases with complications.
• Supportive treatment:
  • Fluid and electrolyte replacement, fever reduction (acetaminophen recommended), and nutritional support.
  • Temperature control in cases of high fever (such as wiping the body with lukewarm water).
  • Prohibited: Avoid aspirin (which may pose a risk of sudden hypotension and bleeding) and strong laxatives/enemas (risk of intestinal perforation).
• Treatment of complications:
  • Intestinal perforation/severe bleeding: Surgical treatment is necessary.
  • Chronic carriers (gallbladder carriers): Long-term antibiotic therapy; cholecystectomy may be considered if necessary.
• Infection control:
  • Patient isolation and hygiene management (handwashing and feces disposal), prohibition of food preparation (especially for carriers), etc.

Checklist Before an Outpatient Visit (Items to Bring and Example Questions)

• Items to bring (when visiting the hospital):
  • A list of all medications currently being taken (including prescription drugs, over-the-counter drugs, and supplements)
  • Recent temperature records (fever pattern), and a log of the symptom onset date and course
  • Recent test results, if available (blood tests and culture results)
  • Travel history (whether you have visited another country or a contaminated area within the past 3 months) and food history (consumption of potentially contaminated food)
  • Contact information (whether any family members or coworkers have similar symptoms)
  • Vaccination records (whether you have received a typhoid vaccine)
• Information to tell the doctor first during the outpatient visit:
  • How long the high fever has continued, whether diarrhea or constipation is present, and whether there is bloody stool or black stool
  • Whether there is vomiting or dehydration, altered consciousness, or severe abdominal pain
  • Whether antibiotics have recently been taken (to consider resistance)
• Example questions (questions patients can check for themselves before the consultation):
  • "When did the symptoms begin?"
  • "Does anyone in your family or among your coworkers have similar symptoms?"
  • "Have you recently consumed water or food that may have been contaminated?"

Examples of General Questions to Ask the Doctor

• "What antibiotic do you recommend for me now, and how long is the expected treatment period?"
• "What are the main side effects of this medication, and what precautions should I take while taking it?"
• "How likely is it that the disease will recur or that I will become a chronic carrier after treatment?"
• "What are the signs of complications, such as intestinal perforation, and what should I do immediately if these symptoms appear?"

Examples of Disease-Specific Questions

• "Can I continue to shed the bacteria even after my symptoms have disappeared? What tests are used to determine whether I am a carrier before discharge or returning to work or school?"
• "Can I become infected even though I received a typhoid vaccine in the past? If vaccination is needed before travel, when should I receive it?"