What is typhoid fever?

Typhoid fever is an acute illness associated with fever that is most often caused by the Salmonella typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually leads to a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area. The incidence of typhoid fever in the United States has markedly decreased since the early 1 !!s. Today, appro"imately #!! cases are reported annually in the United States, mostly in people who recently have traveled to endemic areas. This is in comparison to the 1 $!s, when over %&,!!! cases were reported in the U.S. This improvement is the result of improved environmental sanitation. 'e"ico and South (merica are the most common areas for U.S. citi)ens to contract typhoid fever. India, *akistan, and +,ypt are also known hi,h-risk areas for developin, this disease. Worldwide, typhoid fever affects more than 1% million people annually, with over &!!,!!! patients dyin, of the disease. If travelin, to endemic areas, you should consult with your health-care professional and discuss if you should receive vaccination for typhoid fever. .ow do patients ,et typhoid fever? Typhoid fever is contracted by the in,estion of the bacteria in

contaminated food or water. *atients with acute illness can contaminate the surroundin, water supply throu,h stool, which contains a hi,h concentration of the bacteria. /ontamination of the water supply can, in turn, taint the food supply. (bout %0&0 of patients become carriers of the bacteria after the acute illness. Some patients suffer a very mild illness that ,oes unreco,ni)ed. These patients can become lon,-term carriers of the bacteria. The bacteria multiplies in the ,allbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewa,e. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years. .ow does the bacteria cause disease, and how is it dia,nosed? (fter the in,estion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow. The bacteria then multiply in the cells of these or,ans and reenter the bloodstream. *atients develop symptoms, includin, fever, when the or,anism reenters the bloodstream. 1acteria invade the ,allbladder, biliary system, and the lymphatic tissue of the bowel. .ere, they multiply in hi,h numbers. The bacteria pass into the intestinal tract and can be identified for dia,nosis in cultures from the stool tested in the laboratory. Stool cultures are sensitive in the early and late sta,es of the disease but often must be supplemented with blood cultures to make the

definite dia,nosis. What are the symptoms of typhoid fever? The incubation period is usually one to two weeks, and the duration of the illness is about four to si" weeks. The patient e"periences poor appetite,

headaches,

,enerali)ed aches and pains,

fever,

lethar,y,

diarrhea. *eople with typhoid fever usually have a sustained fever as hi,h as 1!% 2-1!# 2 3% /-#! /4.

/hest con,estion develops in many patients, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. (bout 1!0 of patients have recurrent symptoms 3relapse4 after feelin, better for one to two weeks. 5elapses are actually more common in individuals treated with antibiotics. .ow is typhoid fever treated, and what is the pro,nosis? Typhoid fever is treated with antibiotics that kill the Salmonella bacteria. *rior to the use of antibiotics, the fatality rate was $!0. 6eath occurred from overwhelmin, infection, pneumonia, intestinal bleedin,, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 10-$0. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 1! days. Several antibiotics are effective for the treatment of typhoid fever. /hloramphenicol was the ori,inal dru, of choice for many years. 1ecause of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics needs to be ,uided by identifyin, the ,eo,raphic re,ion where the or,anism was ac7uired and the results of cultures once available. 3/ertain strains from South (merica show a si,nificant resistance to some antibiotics.4 /iproflo"acin 3/ipro4, ampicillin 38mnipen, *olycillin, *rincipen4, and trimethoprim-sulfametho"a)ole

31actrim, Septra4 are fre7uently prescribed antibiotics. If relapses occur, patients are retreated with antibiotics. The carrier state, which occurs in %0-&0 of those infected, can be treated with prolon,ed antibiotics. 8ften, removal of the ,allbladder, the site of chronic infection, will cure the carrier state. 2or those travelin, to hi,h-risk areas, vaccines are now available. Typhoid 2ever (t ( 9lance Typhoid fever usually is caused by Salmonellae typhi bacteria. Typhoid fever is contracted by the in,estion of contaminated food or water. 6ia,nosis of typhoid fever is made when the Salmonella bacteria is detected with a stool culture. Typhoid fever is treated with antibiotics. Typhoid fever symptoms are poor appetite, headaches, ,enerali)ed aches and pains, fever, and lethar,y. (ppro"imately %0-&0 of patients become carriers of the bacteria after the acute illness. 5+2+5+:/+; United States. /enters for 6isease /ontrol and *revention. <Typhoid 2ever.< 8ct. $#, $!!&. .