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