TYPHOID FEVER

INTRODUCTION

Typhoid fever is caused by certain types of the gram-negative bacteria Salmonella typhii. It typically causes a high fever and abdominal pain.

Typhoid fever can be spread by consuming food or water contaminated with the stool or urine of an infected person.

People have flu-like symptoms, sometimes followed by delirium, cough, exhaustion, occasionally rash, and diarrhea.

Samples of blood, stool, other body fluids, or tissues are sent to a laboratory to grow (culture) the bacteria.

To prevent infection, people traveling to areas where typhoid fever is common should be vaccinated and, when there, should avoid certain foods and not drink unbottled water.

Infected people with or without symptoms are treated with antibiotics.

Typhoid fever is one type of infection caused by Salmonella bacteria. There are many types of Salmonella, but most typhoid fever is caused by Salmonella Typhi.

Typhoid fever is common in developing countries (especially in southern Asia) where sanitary conditions are poor. Most cases in the Africa are acquired while traveling in countries where the infection is common.

Transmission

Salmonella Typhi is present only in people.

• People who are infected excrete the bacteria in stool and, rarely, in urine. A few infected people develop chronic infection of the gallbladder or urinary tract. They continue to excrete the bacteria in stool or urine, even though they no longer have any symptoms. Such people are called carriers.
• Salmonella Typhi bacteria may contaminate food or drink when hands are inadequately washed after defecation or urination. Water supplies may be contaminated when sewage is inadequately treated. Flies may spread the bacteria directly from stool to food.
• Occasionally, typhoid fever is spread by direct contact among children during play or between adults during anal-oral sex.
• Like all Salmonella bacteria, many of these bacteria must be consumed for infection to develop, unless the immune system is impaired or people have a deficiency of stomach acid. Stomach acid tends to destroy Salmonella bacteria.

Spread through the bloodstream

The bacteria spread from the digestive tract to the bloodstream (causing bacteremia) and may infect distant organs such as the following:

• Liver, spleen, and gallbladder
• Lungs (causing pneumonia)
• Joints (causing infectious arthritis)
• Kidneys (causing glomerulonephritis)
• Heart valves (causing endocarditis)
• Genital tract
• The tissues covering the brain and spinal cord (causing meningitis)
• Bone (causing osteomyelitis)
• These infections develop mainly when people are not treated or when treatment is delayed.

Symptoms of Typhoid Fever

Typically, a flu-like illness begins about 8 to 14 days after infection. Typhoid fever symptoms begin gradually. People may have a fever, headache, sore throat, muscle and joint pains, abdominal pains, and a dry cough. They may lose their appetite.

After a few days, the temperature peaks at about 103 to 104° F (39 to 40° C), remains high for another 10 to 14 days, and returns to normal during the fourth week after symptoms started. Often the heartbeat is slow, and people feel exhausted. When the infection is severe, they may become delirious.

During the second week, a rash of flat, rose-colored spots develops on the chest and abdomen in about 10 to 20% of people.

Risk factors

Typhoid fever is a serious worldwide threat and affects about 27 million or more people each year. The disease is established in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you're at increased risk if you:

• Work in or travel to areas where typhoid fever is established
• Work as a clinical microbiologist handling Salmonella typhi bacteria
• Have close contact with someone who is infected or has recently been infected with typhoid fever
• Drink water polluted by sewage that contains Salmonella typhi

Complications

Intestinal bleeding or holes

Intestinal bleeding or holes in the intestine are the most serious complications of typhoid fever. They usually develop in the third week of illness. In this condition, the small intestine or large bowel develops a hole. Contents from the intestine leak into the stomach and can cause severe stomach pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care.

Other, less common complications

Other possible complications include:

• Inflammation of the heart muscle (myocarditis)
• Inflammation of the lining of the heart and valves (endocarditis)
• Infection of major blood vessels (mycotic aneurysm)
• Pneumonia
• Inflammation of the pancreas (pancreatitis)
• Kidney or bladder infections
• Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
• Psychiatric problems, such as delirium, hallucinations and paranoid psychosis
• With quick treatment, nearly all people in industrialized nations recover from typhoid fever. Without treatment, some people may not survive complications of the disease.

Prevention

Safe drinking water, improved sanitation and adequate medical care can help prevent and control typhoid fever. Unfortunately, in many developing nations, these may be difficult to achieve. For this reason, some experts believe that vaccines are the best way to control typhoid fever.

A vaccine is recommended if you live in or are traveling to areas where the risk of getting typhoid fever is high.

Vaccines

Two vaccines are available.

One is given as a single shot at least one week before travel.

One is given orally in four capsules, with one capsule to be taken every other day.

Neither vaccine is 100% effective. Both require repeat immunizations because their effectiveness wears off over time.

Because the vaccine won't provide complete protection, follow these guidelines when traveling to high-risk areas:

• Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn't available.
• Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than non-carbonated bottled water.
• Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
• Avoid raw fruits and vegetables. Because raw produce may have been washed in contaminated water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
• Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors — it's more likely to be infected.
• Know where the doctors are. Find out in advance about medical care in the areas you'll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.

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