Typhoid fever causes prolonged high fever, flu-like symptoms, abdominal pain, constipation or diarrhea, rose-colored spots on the chest, and systemic illness that can result in severe illness or death.
Due to this non-specific presentation, patients with typhoid are commonly misdiagnosed with malaria, dengue, or pneumonia.
Historically, health care providers have used first-line antibiotics to successfully treat typhoid infections. However, research indicates that multidrug resistant (MDR) typhoid strains have become increasingly common in typhoid-high burden communities, requiring new and more expensive antibiotics for treatment and increasing hospitalization rates for patients.
Figure 1: Distribution of MDR Typhoid
Another issue affecting the treatment of typhoid is the lack of effective diagnostics. Delayed and inaccurate diagnosis and treatment results in increased costs and higher rates of serious complications and deaths. Without appropriate antibiotic therapy, typhoid mortality ranges from 12-30%.
The current gold standard for diagnosing typhoid fever are blood cultures. However, blood cultures require laboratory support and adequate resources, and are rarely performed in resource-limited settings. Moreover, blood cultures are only 60% sensitive when they are performed.
Treatment of typhoid fever depends on the severity of the case, the availability of follow-up care, and the sensitivity patterns to available antibiotics.
The duration of antibiotic treatment is based on case severity and at least 10-14 days of antibiotic therapy are recommended for severe cases.
Quinalones, including chloramphenicol, amoxacillin, and trimethoprim-sulfamethoxazole, are often the first line of antibiotic treatment. However, S. Typhi has proven to be resistant to these drugs in many regions of the world. Consequently, physicians must rely on more expensive, second-line drugs, including azitrhmycin, cephalosporin, or ciprofloxacin.
Typhoid fever can cause severe complications, including gastrointestinal bleeding and intestinal perforation, which typically require emergency surgery.
Overall, the main determinant of case fatality rate from typhoid fever is delay in treatment. This highlights the need for expanded access to care and for improved diagnostics to differentiate typhoid infections from other confounding illnesses.