Enteric Fever: Causes, Symptoms, Treatment, Diagnosis

Enteric fever is the medical term for type of fever which is popularly known as typhoid fever by the layman. It is a communicable disease caused by ingestion of food or water contaminated by a type of bacteria.

What is Enteric Fever?

Enteric fever is caused by group of bacteria called as Salmonella tyhpi; a lesser severe version of enteric fever is caused by Salmonella paratyphi. Enteric fever, if left untreated or if the condition does not receive the right treatment, it can lead to serious complications including death. In the past, typhoid fever was considered as a deadly disease; however, with improvement in medical field and increased emphasis on sanitation and hygiene, the incidence and severity of this condition is much under control at present. Studies have shown that, enteric fever affects about 21 million people every year, with around 200,000 cases of death from the disease.

Signs and Symptoms of Enteric Fever

Enteric fever may not elicit symptoms immediately after the person is infected. There may be an incubation period of 1 – 2 weeks. The disease may last for a duration of 3 – 4 weeks. Enteric fever may be associated with symptoms such as:

Other symptoms of Enteric fever may include chest congestion and abdominal pain. Fever is almost always constant in nature. Most of the cases show improvement in symptoms by third or fourth week, if there are no other complications. A small number of cases (10%) of Enteric fever may show signs of recurrent symptoms after recovery.

Typhoid progresses when the causative bacteria enter the bloodstream after ingestion of contaminated water or food. It is then carried by the white blood cells in to the spleen, liver and bone marrow. It then multiplies further and re-enters the blood stream. At this point, the affected individual develops fever. The causative bacteria then invade the biliary system, gall bladder and the lymphatic tissue of the bowel where they multiply further, which pass into the intestinal tract and can be noted in the patient’s stool sample.

Causes of Enteric Fever

Enteric fever or thyroid fever is mainly caused by eating or drinking food or water contaminated by Salmonella bacteria. People infected with Enteric fever can further cause the spread of disease by contamination of water through their stool. Contaminated water can further cause contamination of food. The intensity of contamination is worse as these bacteria can survive for weeks in water or even in dried sewage wastes.

In few cases of Enteric fever (about 3 – 5%), the affected individual may behave as a carrier after being infected once. In some cases, people may be mildly affected and the condition goes unnoticed. These individuals usually become long term carrier and thus become the source of new out-break of disease. Children are at a higher risk of developing Enteric fever or typhoid fever than adults. The chances of developing Enteric fever or typhoid increases in the following situation:

  • Traveling to or working in area endemic to typhoid fever
  • Occupations such as clinical microbiologist (which may require regular handling of Salmonella typhi bacteria)
  • Close contact with individuals affected by salmonella bacteria
  • Contamination of source of drinking water with Salmonella typhi.

Diagnosis and Treatment of Enteric Fever

Diagnosis of Enteric fever or typhoid fever is done by an experienced physician. It involves obtaining a detailed case history followed by physical examination of the person. Lab work includes blood tests, stool tests and urine tests. Treatment of Enteric fever or typhoid fever is done with antibiotics, which help in killing the bacteria. Before the use of antibiotics for treatment of typhoid fever, the fatality of this condition was as high as 20%. Death is usually caused due to intestinal bleeding, intestinal perforation or pneumonia from bacterial action. With improvement in medicine, the mortality rate of enteric fever has reduced to 1 – 2% with antibiotics and supportive care.

Improvement is noted in about 1 to 2 days and complete recovery is noted within 7 to 10 days.

In the past, chloramphenicol was the choice of antibiotics to treat Enteric fever; however, over the years, the use of this drug has been reduced due to the side effects associated with it. At present, the choice of drug for treating Enteric fever depends on the causative agent. For people travelling to areas prone to typhoid, it is recommended to take vaccination before visiting the area.

Conclusion

Enteric fever (also known as typhoid fever) is caused due to ingestion of food or water contaminated with a bacteria called as salmonella typhi. The symptoms are often noted after a period of incubation (1 to 2 weeks) for about 3 – 4 weeks. Diagnosis often involves general examination followed by specific tests such as blood work, stool examination and urine analysis. Enteric fever is a communicable disease and spreads from infected patients to the community if preventive measures are not taken or if hygienic standards are not followed. In case of travel plans to endemic areas of enteric fever, a vaccination is highly recommended.

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