Typhoid Fever

Introduction

     Typhoid fever is an infection caused by bacteria that is spread through contaminated food. The bacteria enter the host through the intestinal system, and migrate to other parts of the body through the bloodstream.

Causes

• The cause of the disease is a bacterium known as Salmonella typhi.  Once it enters the host, it spreads via the bloodstream and begins to multiply in different parts of the body, including the lungs, kidneys, gallbladder, and brain.

Symptoms

• Severe headache

• Fever

• Loss of Appetite

• General discomfort, uneasiness, or ill feeling (malaise)

• Rash (rose spots) appearing on the lower chest and abdomen during the second week of the fever

• Abdominal tenderness

• Constipation, then diarrhea

• Bloody stools

• Slow, sluggish, lethargic

• Fatigue

• Weakness

• Nosebleed

• Chills

• Delirium

• Confusion

• Agitation

• Fluctuating mood

• Difficulty paying attention (attention deficit)

• Hallucinations

Screening and Diagnostics

• An elevated white blood cell count in blood

• A blood culture during first week of the fever can show S. typhi bacteria

• A stool culture

• An ELISA test on urine may show Vi antigen specific for the bacteria

• A platelet count (decreased platelets )

• A fluorescent antibody study (demonstrates Vi antigen, which is specific for typhoid)

Treatment

• Once one contracts the infection, he will need to be treated with antibiotics, given intravenously or by mouth, depending on the severity of the illness.

• The antibiotic most often used is Trimethoprim-sulfamethoxazole.  Other antibiotics that may be used are Ceftriaxone and Ciprofloxacin (but this should not be used in children and pregnant women).  Ampicillin and Chloramphenicol may also be used, but they are often not effective.

• Treatment needs to be continued for 2 weeks.

• Up to 2% of people who develop typhoid fever die.  Older patients and those with other medical conditions have a higher risk of death.  Children usually do fine with treatment.

• Repeat infections occur in up to 15% of those treated.

• People who develop complications have a much higher risk of dying.

Complications

• Intestinal hemorrhage (severe GI bleeding)

• Intestinal perforation

• Kidney failure

• Peritonitis

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.