Manifestations of Typhoid Disease
Typhoid fever, an enteric fever caused by the bacterium Salmonella Typhi, poses significant diagnostic challenges in resource-limited settings. This infectious disease, spread primarily through contaminated water supplies and poor sanitation, remains a major health concern in many developing nations.
In these resource-poor areas, the diagnostic methods for typhoid fever are limited. Blood culture, serological tests like the Widal test and Typhidot, absolute eosinopenia measurement, and PCR each have their advantages and challenges.
Blood Culture, considered the gold standard for diagnosis due to its specificity and ability to confirm active infection, requires laboratory infrastructure, skilled personnel, and several days to yield results. This makes it unavailable in many low-resource areas.
Serological tests, such as the Widal test and Typhidot, are widely used due to their cost-effectiveness and simplicity. However, they suffer from low sensitivity and specificity, leading to misdiagnosis and inappropriate treatment.
Absolute Eosinopenia has been evaluated as a diagnostic marker, showing high specificity but moderate sensitivity. It represents a potentially useful adjunctive test but is not definitive alone.
PCR tests offer higher reliability and potential antibiotic resistance profiling. However, they are costly, require advanced equipment, and are rarely available for routine use in resource-limited settings.
The challenges in these settings include limited laboratory infrastructure and trained personnel, delays in culture results, low accuracy of serological tests, difficulties in detecting antimicrobial resistance, and cost constraints that limit the widespread use of molecular diagnostics.
Anaemia occurs in around 20% of hospitalized patients with typhoid fever, making it the most common complication after gastrointestinal and neurological complications. Neurological complications of typhoid fever are common in children, occurring in around 25% of hospitalized cases.
Complications of typhoid fever, such as severe diarrhea, hepatitis, perforation of the small bowel, and gastrointestinal complications, are more frequent in cases not treated with antibiotics. Perforation of the bowel is a particularly important complication as it carries a high rate of mortality.
Rapid and low-cost diagnostic tests, such as immunological tests, have been developed but are affected by previous infection and infection with other Salmonella species. Rose spots, a rash found in enteric fever, are present in only 25% of patients.
Low white cell and platelet levels are other blood abnormalities that may occur in typhoid fever. The clinical illness of enteric fever develops after an incubation period of 10-14 days and may be characterized by fever, chills, headache, anorexia, abdominal discomfort, vomiting, diarrhea, constipation, upper respiratory symptoms, malaise, and myalgia.
Physical findings specific to enteric fever may include pallor, lethargy, dehydration, signs of sepsis, fever, Rose spots, hepatomegaly, splenomegaly, jaundice, relative bradycardia, abdominal tenderness, guarding, rebound tenderness, and abnormalities of the blood on complete blood count.
Diseases in the differential diagnosis of typhoid fever include malaria, bacterial meningitis, amoebiasis, leptospirosis, scrub and murine typhus, brucellosis, bacterial gastroenteritis (e.g. Salmonella), COVID-19, influenza, viral hepatitis, Chikungunya, viral meningitis, yellow fever, and dengue fever.
Inappropriate secretion of ADH is a rare complication of typhoid fever. Antibiotics are used to treat enteric fever, but there is a rising concern about multidrug-resistant and extensively drug-resistant strains. Delirium, febrile seizures, encephalopathy, psychosis, ataxia, and muscle rigidity are neurological complications of typhoid fever.
In 2019, there were 9.2 million cases of enteric fever worldwide, resulting in 110,000 deaths. Myocarditis (inflammation of the heart muscle) and focal lung infections, including pneumonia and lung abscesses, are cardiovascular and respiratory complications of typhoid fever.
In summary, while blood culture remains the diagnostic gold standard, its feasibility is limited in resource-poor areas. Serological tests are accessible but unreliable, PCR offers promise but is not yet broadly implementable, and rapid diagnostic tests are affected by previous infections and other Salmonella species. Thus, diagnostic challenges involve balancing accessibility, accuracy, and timeliness to improve typhoid fever management in these settings.
In resource-poor areas, there is a need for alternative diagnostic methods for typhoid fever due to the limitations and challenges associated with blood culture, serological tests, PCR, and rapid diagnostic tests, which can be affected by factors such as lack of laboratory infrastructure, low sensitivity, cost, and limited availability in these settings.
As a potential solution, health-and-wellness practices and medical-conditions research could explore the use of CBD as a holistic approach in managing symptoms and complications of typhoid fever, considering its potential anti-inflammatory, analgesic, and immune-modulating effects, as well as its safety profile and growing acknowledgement in health and wellness sectors.
