Patient's Complete Guide to Enteric Fever

Overview of Enteric Fever

Enteric fever or typhoid is a systemic illness (affects the whole body) that is caused by ingesting contaminated food and spreads through human carriers.

Signs and Symptoms of Enteric Fever

Enteric fever is a systemic illness (affects the whole body) caused by bacteria, Salmonella enterica. The illness occurs by ingesting contaminated food or drinking water and spreading through human carriers. It is an acute form of illness characterized by fever, diarrhea, vomiting and can sometimes be fatal.
The commonly known name used for enteric fever is, “Typhoid fever”. Enteric fever refers to both types; typhoid fever and paratyphoid fever.  Enteric fever meaning in urdu is, آنت بخار’.

Occurrence

It is distributed around the globe but its occurrence is more in developing countries with unhygienic conditions especially in children. Enteric fever or typhoid has the highest incidence in Asia, according to the ‘Surveillance Report on Typhoid Fever Epidemiology”.
According to a report by ‘Infection landscapes’, Enteric fever is putting more burden than cholera worldwide. It affects more than 22 million people with 200,000 deaths per year. The fatality rate of untreated enteric fever is 1 in every 5 cases i.e. 20%.

Types of Enteric Fever

The main symptoms of enteric fever are high fever and rashes. Symptoms include;

  • High fever (~104oF) for several days
  • Red colored spots or rashes specifically on abdomen and neck
  • Malaise (body fatigue)
  • Headache
  • Stomach pains
  • Loss of appetite

The bacterium causing the enteric fever can live for days and multiplies in your body. However, symptoms may develop after 3 weeks of exposure to bacteria. Symptoms also resemble other illnesses, so always consult your doctor for particular diagnosis.

Don’t confuse Enteric fever with Typhus!

Typhus is a vector-borne disease with somewhat similar clinical presentation (signs and symptoms) to enteric fever, that even physicians would find difficulty in diagnosis on the basis of symptoms alone. Nonetheless, both of these diseases are quite distinct from each other in terms of pathogenicity, cause and mode of transmission.

Risk Factors of Enteric Fever

Enteric fever is caused by a gram-negative bacterium, Salmonella enterica. Another serovar, Salmonella typhi is responsible for causing typhoid fever while Salmonella paratyphi causes paratyphoid fever.

How is the bacteria transmitted?

The enteric fever bacteria are found in contaminated (polluted) places i.e. unhygienic food or impure water. Mostly, it is transmitted through fecal-oral routes. Drinking contaminated water, eating fish from sewage polluted areas, raw fruits and vegetables from the soil fertilized by human excreta and consuming contaminated dairy products. Flies may transfer the infectious agents from one place to another i.e. foods, and by consuming such food will lead you towards the infection.

Pathogenesis of enteric fever

Salmonella typhi enters through the mouth in the form of food, and moves to the intestine where it stays for 1-3 weeks. Then, it goes into the bloodstream through the intestinal wall. It spread to various body organs through the bloodstream. Despite the body’s immune response, Salmonella typhi can live within the body, multiples there and affects the body organs.
The pictorial description of the route S. typhi pathogenesis is shown here.

Can animals spread enteric fever?

No! The bacterium causing enteric fever lives only in humans, so the disease is transmitted through direct human contact.

Diagnosis

Practicing good hygiene will prevent you from getting the infection. You should consider the following points:

  • Use boiled or chemically disinfected water
  • Wash your hands and face with soap and water or alcohol-based sanitizer if water is not available
  • Properly wash raw fruits and vegetables before consuming them
  • Wash the surface of tins, bottles and cans carrying the eatables
  • Avoid the use of raw meat
  • Use pasteurized milk
  • Do not eat food from open places restaurants

Treatment of Enteric Fever | When to Consult a Doctor

  • Medical and travel history

A doctor will ask you about your medical history, travel history and suspect your symptoms.

  • Laboratory tests

Enteric fever is further diagnosed by laboratory tests to detect the presence bacteria during the first week, that include;

  • Blood culture test
  • Stool sample test
  • Urine sample test
  • Tissue culture

A small sample of your blood, stool, urine or bone marrow is taken to detect the bacterial growth. Microscopy is performed for cultures. A bone marrow culture test is more sensitive for bacterial detection in enteric fever.

  • Widal test

This test looks for the antibodies produced by the person affected by enteric fever. S. typhi antigens are used to detect the presence of antibodies specific to S. typhi. Although the Widal test is affordable and convenient, there exist some concerns about its reliability.

WHO has shown concern on the Widal test!!

They recommended that not just rely on this antibody detection test, use other diagnostic culture tests for authentic diagnosis.
The infection stages of enteric fever along with its diagnosis is tabulated here:

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