Typhoid fever natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Overview

Symptoms of typhoid fever, which usually begin to develop 5 to 21 days after ingestion of the causative organism, include fever, headache, malaise, and bradycardia. If left untreated, the patient will develop complications in the second or third week of illness such as intestinal perforation, intestinal hemorrhage, typhoid encephalopathy, meningitis, disseminated intravascular coagulation, miscarriage, or relapse.[1][2][3][4][5][6][7][8][9][10][11][12] Without therapy, the illness may last for 3 to 4 weeks and mortality rates range between 12% and 30%. The prognosis of typhoid fever varies depending on the local incidence rate. The mortality rate of typhoid fever in endemic areas is 1-4% with treatment, while it is less than 1% with treatment in areas with low incidence of typhoid fever.[13][14]

Natural history

The symptoms of typhoid fever usually develop 5 to 21 days after ingestion of the causative organism.[12][15][16][17][18]

First Week Second Week[12] Third Week Fourth Week[16][19]
  • Prostration
  • High grade fever which plateaus around 40°C
  • Bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave
  • Delirium or agitation (nervous fever)
  • Rose spots on the lower chest and abdomen (1/3 patients)
  • Rhonchi in lung bases
  • Abdominal pain (right lower quadrant)
  • Diarrhea (six to eight stools/day), green with a characteristic smell, comparable to pea-soup[20]
  • Constipation
  • Resolution
  • Chronic carrier state[14]
  • Death

Complications

Common complications of typhoid fever include:[2][3][4][5][6][7][9][10][11][21][22]

Gastrointestinal

Neurologiocal

Cardiovascular

Respiratory

Heamatologic

Other

Prognosis

Worldwide, the prognosis of typhoid fever varies depending on the local incidence rate. The mortality rate of typhoid fever in endemic areas is 1-4% with treatment as compared to 10-30% without treatment.[13] However, the mortality rate in the areas with low incidence of typhoid fever is less than 1% with treatment.[14]

  • Favorable prognostic factors:
  • Early diagnosis and treatment[25]
  • Susceptibility to drugs[26]
  • Less virulent strain[27]
  • Good compliance
  • Poor prognostic factors:

References

  1. ↑ Bitar, Roger, and John Tarpley. "Intestinal perforation in typhoid fever: a historical and state-of-the-art review." Review of Infectious Diseases 7.2 (1985): 257-271.
  2. ↑ 2.0 2.1 van Basten JP, Stockenbrügger R (1994). "Typhoid perforation. A review of the literature since 1960". Trop Geogr Med. 46 (6): 336–9. PMID 7892698.
  3. ↑ 3.0 3.1 3.2 Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR; et al. (1984). "Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone". N Engl J Med. 310 (2): 82–8. doi:10.1056/NEJM198401123100203. PMID 6361558.
  4. ↑ 4.0 4.1 Punjabi NH, Hoffman SL, Edman DC, Sukri N, Laughlin LW, Pulungsih SP; et al. (1988). "Treatment of severe typhoid fever in children with high dose dexamethasone". Pediatr Infect Dis J. 7 (8): 598–600. PMID 3050856.
  5. ↑ 5.0 5.1 5.2 Seoud M, Saade G, Uwaydah M, Azoury R (1988). "Typhoid fever in pregnancy". Obstet Gynecol. 71 (5): 711–4. PMID 3357660.
  6. ↑ 6.0 6.1 Reed RP, Klugman KP (1994). "Neonatal typhoid fever". Pediatr Infect Dis J. 13 (9): 774–7. PMID 7808844.
  7. ↑ 7.0 7.1 7.2 Wain J, Hien TT, Connerton P, Ali T, Parry CM, Chinh NT; et al. (1999). "Molecular typing of multiple-antibiotic-resistant Salmonella enterica serovar Typhi from Vietnam: application to acute and relapse cases of typhoid fever". J Clin Microbiol. 37 (8): 2466–72. PMC 85257. PMID 10405386.
  8. ↑ Levine, Myron M., Robert E. Black, and Claudio Lanata. "Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area." Journal of Infectious Diseases 146.6 (1982): 724-726.
  9. ↑ 9.0 9.1 9.2 Gupta SP, Gupta MS, Bhardwaj S, Chugh TD (1985). "Current clinical patterns of typhoid fever: a prospective study". J Trop Med Hyg. 88 (6): 377–81. PMID 3837121.
  10. ↑ 10.0 10.1 10.2 Huang DB, DuPont HL (2005). "Problem pathogens: extra-intestinal complications of Salmonella enterica serotype Typhi infection". Lancet Infect Dis. 5 (6): 341–8. doi:10.1016/S1473-3099(05)70138-9. PMID 15919620.
  11. ↑ 11.0 11.1 Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS; et al. (2012). "Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border". Clin Infect Dis. 54 (8): 1100–6. doi:10.1093/cid/cis012. PMID 22357702.
  12. ↑ 12.0 12.1 12.2 12.3 Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD; et al. (2012). "A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009". Clin Infect Dis. 54 (8): 1091–9. doi:10.1093/cid/cis025. PMID 22357703.
  13. ↑ 13.0 13.1 Daul CB, deShazo RD, Andes WA, Pankey GA (1986). "Immunologic studies in homosexual and hemophiliac subjects with persistent generalized lymphadenopathy: a comparative analysis". J Allergy Clin Immunol. 77 (2): 295–301. PMID 3484760.
  14. ↑ 14.0 14.1 14.2 Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J; et al. (2009). "Typhoid fever in the United States, 1999-2006". JAMA. 302 (8): 859–65. doi:10.1001/jama.2009.1229. PMID 19706859.
  15. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0140-6736(98)09 Check |pmid= value (help).
  16. ↑ 16.0 16.1 Crump JA, Luby SP, Mintz ED (2004). "The global burden of typhoid fever". Bull World Health Organ. 82 (5): 346–53. PMC 2622843. PMID 15298225.
  17. ↑ Khanam F, Sayeed MA, Choudhury FK, Sheikh A, Ahmed D, Goswami D; et al. (2015). "Typhoid fever in young children in Bangladesh: clinical findings, antibiotic susceptibility pattern and immune responses". PLoS Negl Trop Dis. 9 (4): e0003619. doi:10.1371/journal.pntd.0003619. PMC 4388457. PMID 25849611.
  18. ↑ Bose KS, Sarma RH (1975). "Delineation of the intimate details of the backbone conformation of pyridine nucleotide coenzymes in aqueous solution". Biochem Biophys Res Commun. 66 (4): 1173–9. PMID Epidemiology, clinical presentation, labo result2 Epidemiology, clinical presentation, labo Check |pmid= value (help).
  19. ↑ http://www.cdc.gov/typhoid-fever/symptoms.html
  20. ↑ Gotuzzo E, Frisancho O, Sanchez J, Liendo G, Carrillo C, Black RE; et al. (1991). "Association between the acquired immunodeficiency syndrome and infection with Salmonella typhi or Salmonella paratyphi in an endemic typhoid area". Arch Intern Med. 151 (2): 381–2. PMID 1899554.
  21. ↑ Levine, Myron M., Robert E. Black, and Claudio Lanata. "Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area." Journal of Infectious Diseases 146.6 (1982): 724-726.
  22. ↑ Bitar, Roger, and John Tarpley. "Intestinal perforation in typhoid fever: a historical and state-of-the-art review." Review of Infectious Diseases 7.2 (1985): 257-271.
  23. ↑ Bitar, Roger, and John Tarpley. "Intestinal perforation in typhoid fever: a historical and state-of-the-art review." Review of Infectious Diseases 7.2 (1985): 257-271.
  24. ↑ Ali G, Rashid S, Kamli MA, Shah PA, Allaqaband GQ (1997). "Spectrum of neuropsychiatric complications in 791 cases of typhoid fever". Trop Med Int Health. 2 (4): 314–8. PMID 9171838.
  25. ↑ Swan SK, Gilbert DN, Kohlhepp SJ, Leggett JE, Kohnen PW, Bennett WM (1992). "Duration of the protective effect of polyaspartic acid on experimental gentamicin nephrotoxicity". Antimicrob Agents Chemother. 36 (11): 2556–8. PMC 284375. PMID 1489205.
  26. ↑ Bhutta, Zulfiqar A., and Husein Lalji Dewraj. "Current concepts in the diagnosis and treatment of typhoid fever." British Medical Journal 7558 (2006): 78.
  27. ↑ Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL (2015). "Typhoid fever". Lancet. 385 (9973): 1136–45. doi:10.1016/S0140-6736(13)62708-7. PMID 25458731.
  28. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID :10.1136/adc.75.3.214 Check |pmid= value (help).
  29. ↑ Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.
  30. ↑ Chalya PL, Mabula JB, Koy M, Kataraihya JB, Jaka H, Mshana SE; et al. (2012). "Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting". World J Emerg Surg. 7: 4. doi:10.1186/1749-7922-7-4. PMC 3311140. PMID 22401289.
  31. ↑ 31.0 31.1 Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.
  32. ↑ Van Belle H, Goossens F, Wynants J (1987). "Formation and release of purine catabolites during hypoperfusion, anoxia, and ischemia". Am J Physiol. 252 (5 Pt 2): H886–93. PMID 3578539.
  33. ↑ Bhutta ZA (1996). "Impact of age and drug resistance on mortality in typhoid fever". Arch Dis Child. 75 (3): 214–7. PMC 1511710. PMID 8976660.

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