Enteric Fever: Causes and treatment of this common disease in Bangladesh

Enteric fever, commonly known as typhoid fever, remains a significant public health concern in Bangladesh.

Caused by the bacteria Salmonella enterica serotypes Typhi and Paratyphi, the disease is primarily transmitted through the ingestion of contaminated food or water. Despite improvements in healthcare, enteric fever continues to affect thousands every year, especially during the summer and monsoon seasons when sanitation and water supply issues become more prominent.

Causes and transmission

Enteric fever spreads via the fecal-oral route, which means the bacteria are excreted in the stool or urine of infected individuals and can contaminate drinking water or food. In Bangladesh, overcrowded urban settings, poor sanitation, and inadequate access to clean drinking water create ideal conditions for the transmission of Salmonella bacteria. Street food vendors, improperly cooked meals, and unwashed vegetables are also common culprits.

Children and young adults are most vulnerable to this infection. It is particularly prevalent in low-income areas where access to hygienic facilities is limited. In addition, people who travel from rural to urban areas often carry the infection with them, facilitating further spread.

Symptoms and clinical features

The symptoms of enteric fever generally begin 6 to 30 days after exposure. Early signs may resemble common viral illnesses, making early diagnosis difficult. Common symptoms include:

• Persistent high fever (often rising in a step-ladder pattern)
• Weakness and fatigue
• Abdominal pain
• Headache
• Loss of appetite
• Constipation or diarrhea
• Rose-colored spots on the chest and abdomen (in some cases)

If not treated properly, enteric fever can lead to severe complications such as intestinal hemorrhage, perforation, encephalopathy, or even death.

Diagnosis and treatment

Due to its similarity with other febrile illnesses like malaria or dengue, accurate diagnosis of enteric fever is crucial. Common diagnostic tests include:

• Blood culture (most reliable in the early stage)
• Widal test (less specific, but widely used in low-resource settings)
• Stool and urine cultures (used later in the disease)

Treatment typically involves antibiotics. First-line drugs include ciprofloxacin, azithromycin, and ceftriaxone. However, antibiotic resistance is an increasing concern in Bangladesh. Multi-drug-resistant (MDR) and extensively drug-resistant (XDR) strains of Salmonella Typhi have been reported, complicating treatment efforts.

Supportive care, including hydration and nutrition, plays a vital role in patient recovery. In severe cases, hospitalization may be necessary.

Preventive measures

Preventing enteric fever requires a multi-faceted approach, especially in endemic areas like Bangladesh:

1. Safe Water Supply: Access to clean drinking water is the most crucial step in preventing infection. Boiling water or using water purification tablets can reduce the risk significantly.

2. Improved Sanitation: Proper sewage disposal and hygienic practices, including handwashing with soap after using the toilet and before meals, are essential.

3. Food Safety: Avoiding raw or undercooked food, washing vegetables thoroughly, and ensuring food from vendors is cooked and served hot can prevent infection.

4. Vaccination: Vaccines are available for typhoid fever, such as the Typhoid Conjugate Vaccine (TCV), which provides long-term protection. The Government of Bangladesh has recently taken steps to include TCV in the national immunization program, targeting children and high-risk populations.

5. Public Awareness: Educational campaigns on hygiene and disease transmission are necessary to control the spread of enteric fever. Media, schools, and local health authorities can play vital roles in spreading awareness.

Current situation in Bangladesh

Despite growing awareness and medical advancements, enteric fever continues to be a leading cause of morbidity in Bangladesh. Outbreaks are common during monsoon seasons due to flooding and water contamination. Urban slums and refugee camps are particularly vulnerable due to poor hygiene conditions.

Non-governmental organizations (NGOs), international health bodies, and local health departments are collaborating to enhance surveillance, promote vaccinations, and improve access to safe drinking water. However, challenges remain due to population density, poverty, and infrastructural limitations.

Enteric fever is a preventable yet persistent public health threat in Bangladesh. Combating it requires collective efforts in improving sanitation, water quality, medical treatment, and public education. With rising concerns over antibiotic resistance, the focus must also shift toward prevention through vaccination and community hygiene initiatives. Ensuring these steps are implemented at both grassroots and national levels can drastically reduce the disease burden and improve overall health outcomes across the country.