Typhoid fever

Causes and Risks:
Typhi are spread by contaminated food, drink, or water. Following ingestion, the bacteria spread from the intestine to the intestinal lymph nodes, liver, and spleen via the blood where they multiply. Salmonella may directly infect the gallbladder through the hepatic duct or spread to other areas of the body through the bloodstream.

Early symptoms are very general and include fever , malaise and abdominal pain . As the disease progresses the fever becomes higher (greater than 103 Fahrenheit), and diarrhea becomes prominent. Weakness , profound fatigue , delirium , obtundation and an acutely ill appearance develop. A rash , characteristic only of typhoid and called "rose spots," appears in most cases of typhoid. Rose spots are small (1/4 inch) dark red, flat spots that appear most often on the abdomen and chest. Typically, children have milder disease and fewer complications than adults.

A few people can become carriers of typhoid and continue to shed the bacteria in their feces for years. Although typhoid is common in developing countries, less than 600 cases are reported in the U.S. each year.

Prevention:
Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well cooked food. Experimentation with an oral live attenuated typhoid vaccine is now underway and appears promising.

Adequate water treatment, waste disposal, and protection of food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

Symptoms:



Signs and Tests:
A blood culture during first week of the fever can show Salmonella typhi bacteria. Note: A stool culture is unreliable.

Other tests:



Treatment:
Intravenous fluids and electrolytes are usually given. Appropriate antibiotics are given to fight the bacteria; often chloramphenicol or ampicillin.

Prognosis:
The illness usually resolves in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop. Cases in children are milder, and are more debilitating in the elderly. Relapse may occur if the treatment has not fully eradicated the infection.

Complications:



Call Your Healthcare Provider:
Call your health care provider if you have had any known exposure to typhoid fever or if you have been in an endemic area and symptoms of typhoid fever develop. Also call your health care provider if you have had typhoid fever and relapse occurs or if severe abdominal pain , decreased urine output , or other new symptoms develop.


The causative agent of typhoid fever is the bacterium Salmonella typhi. (Courtesy of the Centers for Disease Control.)



Flies are thought to carry disease by transporting infectious agents on their feet. They may spread polio, hepatitis A, Entameba histalytica, typhoid, and other diseases. (Courtesy of the Centers for Disease Control.)