Typhoid Fever

##Typhoid Fever

1. Definition
   Typhoid fever is an acute febrile disease caused by the bacterium Salmonella Typhi. It is marked by sustained fever, headache, abdominal discomfort and a characteristic rose‑spot rash.

2. Causes / Etiology
   The organism is a gram‑negative bacillus that spreads mainly through ingestion of food or water contaminated with feces of infected persons. Poor sanitation and overcrowding increase the risk.

3. Types or Classification
   ‑ Typhoid fever – infection with Salmonella Typhi, the classic form.
   ‑ Paratyphoid fever – infection with Salmonella Paratyphi A, B or C; symptoms are similar but usually milder.

4. Pathology (stepwise)
   step 1 → Salmonella Typhi is swallowed with contaminated material and reaches the small intestine.
   step 2 → The bacteria penetrate the intestinal mucosa and enter the lymphoid tissue (Peyer's patches).
   step 3 → They multiply and gain access to the bloodstream (bacteremia).
   step 4 → Via the blood they are carried to liver, spleen, bone‑marrow and other organs, producing inflammation and organ enlargement.
   step 5 → The organism is later excreted in bile and stool, perpetuating transmission.

5. Clinical Features

General –

• Fever that rises in a step‑ladder pattern, often reaching 39‑40 °C.
• Headache, malaise and loss of appetite.
• Abdominal pain, constipation or watery diarrhoea.
• Rose‑spot rash on trunk and chest (tiny pink macules).

Specific –

• Bradycardia (slow pulse despite high fever).
• Hepatomegaly (enlarged liver) and splenomegaly.
• Relative leucopenia (low white‑cell count) and mild anaemia.

6. Complications

Acute –

• Intestinal perforation (most common in the third week).
• Peritonitis (infection of the abdominal cavity).
• Gastro‑intestinal bleeding.

Chronic –

• Intestinal strictures leading to obstruction.
• Chronic carrier state (bacteria persist in gall‑bladder or bile ducts).

7. Diagnosis / Investigations

Routine –

• Blood culture (most sensitive in first week).
• Stool culture (positive after the first week).
• Widal test (agglutination test for O and H antibodies; supportive).

Special –

• Bone‑marrow culture (high yield, especially if blood culture negative).
• PCR for Salmonella Typhi DNA (rapid, useful in outbreak settings).

8. Management

General –

• Strict isolation of the patient to prevent spread.
• Adequate bed rest and monitoring of vitals.
• Fluid and electrolyte replacement (oral rehydration or IV if needed).

Modern treatment –

• First‑line antibiotics: Ciprofloxacin 500 mg twice daily for 10‑14 days (if susceptible).
• Alternative agents: Azithromycin 1 g on day 1 then 500 mg daily for 6 days; Ceftriaxone 2 g IV daily for severe cases.
• Antipyretics such as paracetamol for fever control.

Dietary advice –

• Light, easily digestible foods (boiled rice, khichdi, soups).
• Avoid spicy, oily or fried items.
• Maintain good hydration with oral rehydration salts or clear fluids.

9. Homeopathic Therapeutics (key remedies)

Pyrogenium –

• High fever with chill‑sweats.
• Headache and body ache.
• Abdominal pain with diarrhoea.
• Restlessness, anxiety, thirst for cold water.
• Symptoms worse at night, better with warm blankets.

Bryonia –

• Dry, high fever, thirst for large sips of water.
• Headache aggravated by motion.
• Constipation, abdominal cramps.
• Pain worsens on movement, relieved by lying still.

Rhus tox –

• Fever with rash, itching.
• Joint and muscle stiffness, worse on initial movement.
• Restlessness, anxiety, thirst for cold drinks.
• Improves after continued motion.

Arsenic alb –

• Sudden onset fever with chills, profuse diarrhoea.
• Abdominal pain, vomiting, burning thirst.
• Anxiety, restlessness, worse at night.
• Relief with warmth and fresh air.

Gelsemium –

• Low‑grade fever with headache, heaviness of limbs.
• Weakness, lassitude, trembling.
• Abdominal discomfort, mild diarrhoea.
• Symptoms worse on mental exertion, better with rest.