Symptoms of Enteric Fever: Spotting, stopping, and surviving Typhoid and Paratyphoid
Enteric fever, caused by Salmonella typhi and paratyphi, spreads mainly through contaminated food and water. Symptoms include prolonged fever, headache, abdominal pain, and rash. Early diagnosis and treatment are crucial to prevent complications.
What is Enteric Fever The term ‘enteric fever’ refers to both typhoid and paratyphoid fever. This condition is mostly acute, systemic in nature, characterised by headache, abdominal discomfort and fever. It is caused by bacteria called Salmonella typhoid and Salmonella paratyphoid. Paratyphoid fever is generally a milder disease as compared to typhoid (Images: Canva)
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Bacterial Characteristics Salmonella typhoid and S. paratyphoid do not show any stain while the microbiologist adds Gram-Stain to the sample. These organisms have whip-like appendages called flagella that aid in motility. They survive in both oxygen rich and oxygen depleted conditions. They can spread through multiple routes.
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Natural Reservoir and Transmission Unlike dengue, typhoid does not have mosquitoes spreading it. Humans are the only natural reservoir for typhoid. Infected individuals suffering from typhoid may spread it via their infected urine, stools or any other secretions. In chronic carriers, the S. typhi may settle itself in the person’s gallbladder or urinary bladder.
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Modes of Spread Person to person contact can spread typhoid. Ingestion of food, especially dairy products like milk, or other food items like shellfish, that have been contaminated are a common mode of transmission. People who are chronic carriers and handle food can spread the disease to a number of individuals.
Faeco-Oral Route and Incubation Although rare, direct spread of the infection can occur by finger to mouth contact with faeces (called the faeco-oral route), urine or any other secretions of the infected persons. The time between exposure to the Salmonella typhi till the first symptom appears is about 10-14 days (the incubation period).
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Pathogenesis The typhoid bacteria, through ingestion of contaminated food, water or milk, are able to survive the hostile and acidic gastric environment and reach the small intestine. They further enter the bloodstream through the lymphatic channels and then colonise the liver, gallbladder and spleen along with the bone marrow.
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Early symptoms The onset of this disease is slow and gradual, and those who are affected may not have any specific symptoms. General features like headache, fever and bloating can be observed. Some people may also have episodes of nausea and vomiting, abdominal pain with bloating and anorexia.
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Characteristic Fever Enteric fever or typhoid has a characteristic type of fever, which can help in diagnosis. The rising temperature presents in a step-ladder type fashion, going up to 40-41 degree centigrade. The hallmark of this type of fever is that it is continuous, persistent lasting for 4-5 days in some cases and 4-8 in others (who have not been timely treated).
Gastrointestinal and Physical Signs Gastrointestinal symptoms occurring in the early stages include constipation, mostly seen in adults or mild diarrhea, frequent in children more than adults. Abdominal tenderness, enlargement of the liver as well as the spleen can be observed. Due to typhoid, the lymph nodes can become enlarged and become palpable.
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Rose Spots Scanty maculopapular rashes are also seen over the body, these are known as rose-red spots. They are small, about 2-4 millimetres in size pale red in colour. When pressure is applied, they may either blanch or fade. Rose spots are commonly seen on the chest and abdomen and last only for 2-3 days. Biopsy from these lesions can be taken to confirm the diagnosis (Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis)
Rajeshwaari Kalla is a freelance health and wellness writer
