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Video:Coinfection of cholera and typhoid fever

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Description

Coinfection of cholera and typhoid fever is a public health challenge, in areas with poor sanitation and limited access to clean water. While caused by different bacteria,Vibrio cholerae for cholera and Salmonella typhi for typhoid,they share a common mode of transmission through contaminated food and water. This co-occurrence complicates diagnosis, as both diseases can cause fever and gastrointestinal symptoms. Treating a coinfection requires a two-pronged approach, rehydration to combat the severe watery diarrhea of cholera and antibiotics to fight both bacterial infections. An effective long-term solution is to improve water, sanitation, and hygiene infrastructure.[1][2][3]

Presentation

In terms of a co-infection of cholera and typhoid fever would present with a mix of symptoms from both illnesses:[1]severe diarrhea, vomiting , dehydration, fever, abdominal pain, headache and fatigue.

Cause

In terms of etiology we find that:[4][5]Vibrio cholerae: causes cholera, which is characterized by rapid, severe dehydration from profuse watery diarrhea/vomiting, on the other hand, Salmonella Typhi causes typhoid fever, which can be a life-threatening systemic infection.

Risk factor

In terms of risk factors for the coinfection of typhoid and cholera we find the following(as WHO itself has reported such coinfective risks) :[1][6][7]unsafe drinking water, poor sanitation and overcrowding.

Transmission

Both Vibrio cholerae(cholera) and Salmonella Typhi(typhoid fever) are waterborne and foodborne pathogens. [1]They are primarily transmitted through the fecal-oral route, which means that the bacteria are shed in the feces of infected individuals and can contaminate water sources or food.[1]

Diagnosis 1

When assessing this coinfection, stool and blood cultures play key roles in evaluating the individual:[8][9] stool culture identifies V. cholerae in cases of cholera, while blood culture is considered the gold standard for diagnosing early-stage typhoid fever.

Diagnosis 2

Rapid diagnostic test available include:[10][11][12]Cholera RDTs which detect antigens of V. cholerae in stool samples and Typhoid RDTs which detect IgM/IgG antibodies, though their sensitivity can vary.

Prevention

As to prevention improving sanitation and access to clean water is crucial for hampering both diseases and reducing the risk of coinfections.[1]

Treatment

Management of coinfection with cholera and typhoid fever requires a dual approach, which is rapid rehydration with oral or IV fluids to counter cholera-induced dehydration, alongside targeted antibiotic therapy to treat Salmonella Typhi. Azithromycin is often preferred for its efficacy against both pathogens, though local resistance patterns may necessitate alternatives like ceftriaxone or ciprofloxacin for typhoid.[13][14][1]

Epidemiology

Sub-Saharan Africa and South Asia are major hotspots for both diseases, due to inadequate water treatment, and seasonal flooding that worsens transmission. Recent outbreaks such as those in Zimbabwe have highlighted simultaneous surges in both infections prompting concerns about the structural factors driving coinfection.[15]

History

In terms of history the coinfection of cholera and typhoid fever hasn't been attributed to a single discoverer in the traditional sense,like John Snow with cholera. It has emerged from epidemiological observation and mathematical modeling.Lunga Matsebula and Farai Nyabadza have been central to formalizing the understanding of cholera–typhoid coinfection dynamics. Their 2022 study developed a mathematical model to analyze how these two diseases interact within a population.[15][16]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Amicizia, D.; Micale, R. T.; Pennati, B. M.; Zangrillo, F.; Iovine, M.; Lecini, E.; Marchini, F.; Lai, P. L.; Panatto, D. (December 2019). "Burden of typhoid fever and cholera: similarities and differences. Prevention strategies for European travelers to endemic/epidemic areas". Journal of Preventive Medicine and Hygiene. 60 (4): E271 – E285. doi:10.15167/2421-4248/jpmh2019.60.4.1333. ISSN 2421-4248. Archived from the original on 2025-03-13. Retrieved 2025-08-27.
  2. ↑ "Information for Public Health & Medical Professionals | Cholera | CDC". www.cdc.gov. Archived from the original on 20 March 2015. Retrieved 27 August 2025.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  3. ↑ Wain, John; Hendriksen, Rene S.; Mikoleit, Matthew L.; Keddy, Karen H.; Ochiai, R. Leon (21 March 2015). "Typhoid fever". Lancet (London, England). 385 (9973): 1136–1145. doi:10.1016/S0140-6736(13)62708-7. ISSN 1474-547X.
  4. ↑ Chowdhury, Fahima; Ross, Allen G.; Islam, Md Taufiqul; McMillan, Nigel A. J.; Qadri, Firdausi (21 September 2022). "Diagnosis, Management, and Future Control of Cholera". Clinical Microbiology Reviews. 35 (3): e0021121. doi:10.1128/cmr.00211-21. ISSN 1098-6618. Archived from the original on 15 February 2025. Retrieved 1 September 2025.
  5. ↑ Bhandari, Jenish; Thada, Pawan K.; Hashmi, Muhammad F.; DeVos, Elizabeth (2025). "Typhoid Fever". StatPearls. StatPearls Publishing. Archived from the original on 2025-06-23. Retrieved 2025-09-01.
  6. ↑ "Suspected triple outbreak of typhoid fever, shigellosis and cholera – Congo". www.who.int. Archived from the original on 27 December 2024. Retrieved 31 August 2025.
  7. ↑ "Sanitation & Drinking Water". Environmental Performance Index. 3 June 2020. Retrieved 11 September 2025.
  8. ↑ "Cholera Clinical Detection". Cholera. 30 August 2024. Retrieved 5 September 2025.
  9. ↑ Sapkota, Jyotshna; Roberts, Tamalee; Basnyat, Buddha; Baker, Stephen; Hampton, Lee M.; Dittrich, Sabine (May 2023). "Diagnostics for Typhoid Fever: Current Perspectives and Future Outlooks for Product Development and Access". Open Forum Infectious Diseases. 10 (Suppl 1): S17 – S20. doi:10.1093/ofid/ofad120. ISSN 2328-8957. Archived from the original on 2025-02-04. Retrieved 2025-09-15.
  10. ↑ "Rapid Diagnostic Tests: How They Work". CDC. Archived from the original on 12 May 2019. Retrieved 4 September 2025.
  11. ↑ "Global deployment of rapid diagnostic tests to boost fight against cholera". www.who.int. Archived from the original on 2025-06-24. Retrieved 2025-09-14.
  12. ↑ Wijedoru, Lalith; Mallett, Sue; Parry, Christopher M. (26 May 2017). "Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever". The Cochrane Database of Systematic Reviews. 5 (5): CD008892. doi:10.1002/14651858.CD008892.pub2. ISSN 1469-493X. Archived from the original on 28 March 2025. Retrieved 14 September 2025.
  13. ↑ "Treating Cholera". Cholera. 29 May 2025. Archived from the original on 11 March 2015. Retrieved 6 September 2025.
  14. ↑ "Typhoid". www.who.int. Archived from the original on 17 April 2019. Retrieved 6 September 2025.
  15. ↑ 15.0 15.1 Matsebula, Lunga; Nyabadza, Farai (16 September 2022). "Mathematical analysis of cholera typhoid co-infection transmission dynamics". Frontiers in Applied Mathematics and Statistics. 8. doi:10.3389/fams.2022.892098. ISSN 2297-4687. Archived from the original on 22 June 2025. Retrieved 29 August 2025.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  16. ↑ Vinten-Johansen, Peter; Brody, Howard; Paneth, Nigel; Rachman, Stephen; Rip, Michael; Zuck, David (1 May 2003). Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Oxford University Press. p. 231. ISBN 978-0-19-974788-7.
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