Signs of Recovery from Typhoid Fever: Gastroenterologist Explains.

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What you need to Know:

The most important sign of recovery from typhoid fever is to remain free of fever, abdominal pain, and other symptoms for three months after treatment. The signs of recovery can be confirmed by re-testing for the organism (often by blood or bone marrow culture).

Typhoid fever treatment is challenging due to growing antibiotic resistance.
Multidrug-resistant (MDR) and Extensively drug-resistant (EDR) salmonella strains are widespread nowadays.
Making sure of recovery from typhoid fever can be challenging due to late relapses that occur several weeks or months after infection.
Relapse of Salmonella Typhi infection can occur in up to 6% of treated individuals.
To make a full recovery from typhoid fever, you have to remain symptom-free for at least three months after treatment.
The disappearance of fever, abdominal pain, tiredness, altered bowel movements, and rose spots from a period of 90 days after treatment is considered a sign of recovery.
You may continue to have typhoid organisms without having any symptoms (a chronic carrier state).

Continue reading this expert-generated, evidence-based article for the full details about the sure signs of recovery from typhoid fever.

Why checking for recovery is important nowadays.

Typhoid fever treatment is becoming more challenging nowadays. Salmonella bacteria (the cause of typhoid fever) is constantly developing new antibiotic resistance.

You probably heard about the multidrug-resistant (MDR) typhoid. Unfortunately, widespread MDR typhoid is now a global problem with a very high rate of treatment failure.

In addition, A newly-emerged strain with even higher resistance to treatment is called the Extensively drug-resistant (EDR) typhoid.

Both the MDR and the EDR strains of salmonella bacteria cause high rates of treatment failure.

An average of 5% to 10% of patients receiving antibiotics relapse after their initial recovery (reference). And the deterioration can occur several weeks to months after treatment.

That is why it is crucial nowadays to check for the COMPLETE recovery from typhoid fever.

Signs of initial recovery from typhoid fever:

In uncomplicated typhoid fever, antibiotic treatment often produces an initial response in a short time.

It takes about three to five days for antibiotics to produce an initial recovery or improvement for typhoid fever. However, the initial resolution of symptoms doesn’t always mean you have a complete recovery.

The initial signs of recovery from typhoid fever include:

Resolution of fever and chills.
Improvement of abdominal pain.
Improvement of body aches and joint pain.
Bowel habits often turn back to normal (improvement of constipation or diarrhea).
The disappearance of nausea or vomiting.

Also, your doctor may find early laboratory signs of improvement such as:

C-reactive Protein Starts to roll back to normal or near-normal levels.
Liver enzymes (such as ALT and AST) also begin to roll back to normal.
Specific tests such as the antibody titers may also improve on early follow-up.

In the early stage (during the 7-10 days of treatment), clinical signs are more important than laboratory signs to check for improvement.

The most important signs of early recovery are the resolution of fever and abdominal pain.

What are the signs of Full recovery from typhoid?

Typhoid fever passes into different phases, illustrated below (Source: Thypoid fever, deadly diseases, and epidemics book).

In the pre-antibiotic era, death from typhoid fever was 15% or more (reference). Also, survivors in that era suffered from prolonged illnesses that lasted months or years.

Fortunately, death from typhoid fever has dropped to less than 1% (reference).

Due to growing resistance to common antibiotics, persistence or relapse of typhoid fever is common.

5-10% of patients with typhoid fever experience relapse. The same symptoms and signs (fever, abdominal pain, change bowel movements, and body aches) recur again.

How long does it take to recover from typhoid fever completely

In most cases, relapse of typhoid fever occurs one week after you stop taking the antibiotics. However, relapses can take up to 70 days or more to appear (reference).

Complete recovery from typhoid (with little chance of relapse) is considered after the passage of 3 months after initial treatment.

What are the sure signs of recovery from typhoid fever?

The sure sign of recovery from typhoid fever is remaining symptom-free for at least three months after treatment. The combination of the absence of symptoms for three months and negative culture of salmonella is considered a sure sign of recovery from typhoid fever.

The symptoms of relapse of typhoid fever:

The symptoms of relapse are essential the same as the primary disease. The most remarkable difference is that they’re milder.

Consult your doctor if you experience symptoms of typhoid fever again within 90 days of treatment:

Recurrence of fever.
Recurrence of abdominal pain.
Recurrence of diarrhea or constipation.
Recurrence of nausea and vomiting.
Recurrence of muscle aches and headaches.
Recurrence of cough.
Recurrence of rose skin spots.

The chronic typhoid carrier state:

Unfortunately, You may improve clinically but continue to infect others. In addition, the chronic carrier state of Salmonella Typhi organisms can affect up to 6% of patients (reference).

You may continue to shed the salmonella bacteria for up to 12 months after initial treatment. However, shedding salmonella bacteria for more than a year is considered a chronic carrier state.

Often, chronic typhoid carriers have no symptoms at all. However, they represent an infectious risk to others. Moreover, chronic carriers of typhoid in their gallbladder are more prone to gallbladder cancer (reference).

So, identification and treatment of the chronic carrier state are recommended. Treatment of chronic carriers may take up to 4 weeks of antibiotics such as ciprofloxacin (reference).

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