Typhoid Fever - An Overview For Parents

We have been seeing many children with Typhoid fever this season.
It is caused by a bacteria called Salmonella typhi (around 80% of all cases) and paratyphoid fever is caused by Salmonella paratyphi A or B (20%).

Mode of infection:

These bacteria enter the body through the mouth either through contaminated food or water.
The feces or urine of typhoid-infected patients contain these germs and can contaminate water supply systems, especially during the monsoon.
Undercooked food, raw vegetables or contaminated milk and dairy products can also be a source of Salmonella infection

Symptoms & Signs:

• Fever

• Vomiting

• Diarrhea

• Abdominal pain

• Bloated tummy

• Lethargy or tiredness

• Loss of appetite

• Coated tongue

• Liver & spleen enlarged

Fever in Typhoid

The fever may be low-to-moderate and steadily increases in intensity and frequency.
The child appears lethargic in between fever spikes whereas in viral fever usually held is well in between fever.

Lab Tests:

Most reliable test is blood culture, which shows growth of bacteria after 48hours and is the best test for confirming typhoid.
This test has an added value that it also can check which antibiotics will work well.
A negative culture, however, does not rule out typhoid fever.
The chance of getting a positive culture is the highest in the first week of illness.
Prior receipt of antibiotics can interfere with the culture growth giving a falsely negative report.
Hence it is important to do blood culture before starting antibiotics.
Widal Test which is widely followed is not a reliable test for typhoid.

Treatment:

Treatment with antibiotics will be started.
Fever in typhoid declines only gradually and may continue for up to a week even after the correct drugs have been started
Hence, one needs to be patient in these cases and not rush the doctor to change the treatment.
Some cases of typhoid fever, especially if mild and/or detected early, will respond to oral antibiotics.
This is especially true in older children who will take the medicines regularly and reliably without vomiting.

When will admission be required:

• child is feeling very weak

• unable to eat properly

• increased vomiting

• decreased urination

• not responding to oral antibiotics

• complications of typhoid such as bleeding occurs

Diet:

Children should be offered balanced, easily digestible diet with lots of fluids including buttermilk, tender coconut water
Avoid heavy, oily or spicy dishes.
Properly cooked, light non-vegetarian food can be consumed during typhoid fever.

Relapse:

Typhoid fever can occur in 5–10% of patients even after proper treatment and recovery & is known as relapse.
It usually occurs 2–3 weeks after the initial fever resolves and is usually milder.
Relapsed typhoid fever should be treated with the same antibiotics with proper dose and duration.

Vaccination:

Typhoid vaccine should be given to children who have suffered from typhoid, because natural infection does not give long-term protection.
The vaccine may be given as early as 4–6 weeks after recovery

Prevention:

Wash your hands with soap and water before eating or handling food.
Wash your hands after using the toilet & after cleaning your child's stools.
Drink water that has been boiled for at least 1 minute.
Eat food that has been completely cooked and is still hot.
Wash vegetables & fruits well at home before consuming them.
Do not eat raw vegetables or salads or cut fruits from outside.
Do not buy food or drinks from street vendors, especially uncooked ones such as pani puri, juice, chutneys etcetera
Do give Typhoid vaccine if not already given

Dr. Vaishnavi Chandramohan,

Consultant - Pediatrics & Infectious Diseases,

Rainbow Children's Hospital, Marathahalli, Bengaluru

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