typhus

Typhus: description

The word typhus comes from the Greek: typhos means ‘haze’, ‘fog’, ‘dizziness’. This refers to the neurological typhoid symptoms that a patient may be able to develop.

What is typhoid?

Typhoid is a serious diarrheal disease caused by bacteria (salmonella). Doctors differentiate between the abdominal typhus (typhus abdominalis) and the typhoid-like disease (paratyphoid). Every year, approximately 22 million people worldwide contract typhus – the number of deaths is estimated at 200,000 per year. Children are most often affected between the ages of five and twelve. Paratyphus is estimated to have 5.5 million cases per year.

Although the disease occurs worldwide, it is most prevalent in developing countries where poor hygiene conditions prevail. In Africa, South America and Southeast Asia, particularly high numbers of cases as well as recurrent outbreaks and epidemics are known.

If there are typhoid cases in Germany, then the disease is mainly introduced by travelers coming from tropical countries. The highest risk of infection exists in India and Pakistan. In Germany, the number of cases decreased significantly because the hygienic conditions were greatly improved. In 2012, 58 people were diagnosed with typhus and 43 with the typhoid-like disease paratyphoid, according to the Robert Koch Institute (RKI). Typhoid fever is a reportable disease.

There is a typhoid vaccine that can help prevent infection when traveling abroad.

Typhus: symptoms

The following symptoms may occur in typhoid and paratyphoid if the disease remains untreated:

Typhoid fever (typhoid abdominalis)

• Uncharacteristic symptoms such as headache and body aches
• fever between 39 ° C and 41 ° C within two to three days, which may increase slowly and last up to three weeks; a general malaise develops.
• dizziness
• stomach pain
• to cough
• first constipation, from the second week pustular diarrhea
• Characteristic, but rarely are itchy, pinhead-sized, reddish spots on the stomach, chest and back.
• thick, whitish or off-white coating on the main part of the tongue, raspberry-red tip and edges

Typhoid-like disease (paratyphoid)

The disease course of paratyphoid fever is similar to typhoid abdominal, but the symptoms are usually less pronounced. The main symptoms are nausea and vomiting, watery diarrhea, abdominal pain and fever up to 39 ° C. The disease lasts between four and ten days.

Anyone who has survived paratyphoid fever is immune for about a year. However, if those affected are exposed to a high pathogen dose, immunity may be lost again.

Typhus: causes and risk factors

The triggers of typhoid fever are Salmonella. Typhoid abdominalis is caused by the bacterium Salmonella enterica typhi and paratyphus by Salmonella enterica paratyphi. These bacteria are distributed worldwide.

Humans become infected primarily by ingesting contaminated water and foods contaminated by infectious feces (stool, urine). Direct human-to-human transmission is also possible, especially through the hands.

The time between the infection and the onset of the disease (incubation period) is about 3 to 60 days (mostly 8 to 14 days) for typhoid fever and about 1 to 10 days for paratyphoid fever.

There is a risk of infection for other people about one week after the onset of illness, because the germs are excreted with the stool. Even weeks after the typhoid symptoms have subsided, some people excrete bacteria. In two to five percent of the cases, infected individuals even excrete lifelong pathogens without feeling any symptoms. Doctors refer to these persons as Dauerausscheider. These can also be a source of infection for others. In Germany, such Dauerausscheider are usually older than 50 years and more often female than male.

Typhoid: examinations and diagnosis

The beginning of the typhoid diagnosis is the interview (anamnesis). For example, travel to typhoid areas or longer stays abroad by the patient are particularly important. Typhoid and paratyphoid diseases are often confused with influenza infections at the beginning. Returners from the tropics are also confused with malaria and other tropical diseases. If a patient develops a high-fever condition after traveling and continues to do so for four days, typhoid fever or paratyphoid fever should be considered.

A blood test helps to diagnose typhus or paratyphoid fever – a reliable proof. The blood picture shows certain changes, for example, a reduction in white blood cells. The pathogen can be detected directly in the blood. After some time, the bacteria can also be found in the urine and in the stool.

In a study of the bone marrow, typhus or paratyphoid are detectable even after the disease has healed.

Typhoid fever: treatment

Typhoid fever and paratyphoid fever are very serious illnesses that can be severe. Patients should always be treated with antibiotics. The active substance ciprofloxacin is effective, but it is only suitable for adults. Suitable substances are also ceftriaxone, cotrimoxazole and amoxicillin. The classic therapy with chloramphenicol has more possible side effects with the same or lower efficacy – it is therefore no longer the drug of choice.

antibiotics are usually taken as tablets. In particularly severe cases, the substances are administered in hospital in the form of an infusion. The therapy usually lasts two weeks, with a fall in the fever after four to five days. Typhoid antibiotic therapy that fights the bacteria is very successful, especially at the early stages of the disease. The mortality is then usually below one percent and complications rarely occur.

chronic carriers It is recommended to take Ciprofloxacin for four weeks. Good results can also be achieved by a two-week therapy with ceftriaxone. In typhoid patients with gallstones, the typhoid bacteria may colonize the gallbladder. In such cases, removal of the gallbladder must be considered.

A major problem is that in the typhoid areas increasingly resistant bacteria develop, against the common antibiotics such as cotrimoxazole or amoxicillin no longer work. Therefore, experts recommend testing efficacy against isolated pathogens before treatment.

Typhoid fever: prevention

Typhoid vaccine: To protect against typhoid fever (typhoid abdominalis) there is a vaccine. It is recommended for people traveling in risk areas with poor hygienic conditions. The typhoid vaccine is given by syringe and provides protection for about three years. Also possible is an oral typhoid vaccine that gives immunity for about a year. However, the typhoid vaccine does not offer 100% protection either. Only in about two thirds of cases can an outbreak of the disease be prevented. But the typhoid vaccine can alleviate the disease. There is no vaccine against typhoid-like disease (paratyphoid).

Typhoid vaccine

You can read all about the typhoid vaccine in the article Typhoid Vaccination.

hygiene: Important are also targeted hygienic measures that can protect against infection with typhoid bacteria. Typhoid pathogens are transmitted via drinking water in most cases. So it’s best to keep your fingers away from tap water or water from the well in risk areas. Also ice cubes from tap water are rather taboo.

Avoid raw or insufficiently heated food. These include leaf and deli salads, seafood, unpeeled fruit or juices – they can be contaminated with typhoid and paratyphoid pathogens. It’s best to stick to the rule: “Peel it, cook it, or forget it!” – “Peel it, cook it or forget it!”.

If you are in contact with typhoid patients or known permanent excretors, you should often wash and disinfect your hands.

You can do that yourself

Patients with typhoid should drink a lot to make up for the water loss. Also, the electrolyte balance (blood salts) must be brought back into balance. In addition, hygiene is extremely important to prevent infection of contact persons.

Typhoid fever: disease course and prognosis

With early antibiotic therapy, the prognosis for typhus and paratyphoid is very good. Also, balancing the large fluid loss contributes to a quick recovery. The mortality is less than one percent. However, some of the patients can become so-called permanent excretors. So they excrete the pathogen for a long time, although the symptoms have already subsided. They must be treated accordingly, otherwise there is always a certain risk of infection for their fellow human beings.

Remains a disease with typhus or paratyphoid left untreated, the prognosis is much more critical. Before antibiotics were given, about 15 to 20 percent of patients died.