Typhoid fever

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Typhoid fever
Salmonella typhi bacteria
ICD-10	A01.0
ICD-9	002
DiseasesDB	27829
MeSH	D014435

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

History and Symptoms | Physical Examination | Laboratory tests | ECG | EEG | Chest X Ray |CT | Echocardiography or Ultrasound |Other imaging studies | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Prevention | Financial costs| Future therapies

Overview

For a similar disease with a similar name, see typhus.

For a related disease which is caused by a different bacterium, see Paratyphoid fever.

Typhoid fever, also known as enteric fever and Salmonella typhi infection, is an illness caused by the bacterium Salmonella enterica serovar typhi. Common worldwide, it is transmitted by the fecal-oral route — the ingestion of food or water contaminated with feces from an infected person. The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.

Treatment

Doctor administering a typhoid vaccination at a school in San Augustine County, Texas. Photograph by John Vachon, April 1943.

Typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa and Latin America). Typhim Vi is an intramuscular killed-bacteria vaccination and Vivotif is an oral live bacteria vaccination, both of which protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither protects against unrelated typhus.

Primary Prevention

Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself.

Two basic actions can protect you from typhoid fever:

• Avoid risky foods and drinks.
• Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.

Boil it, cook it, peel it, or forget it:

• If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.
• Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.

Getting vaccinated:

If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.

Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

The chart below provides basic information on typhoid vaccines that are available in the United States:

Typhoid vaccines

Resistance

Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid that is resistant to these agents is known as multidrug-resistant] typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone.

There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method. It not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent disc testing and cannot test for MICs.

Risk Stratification and Prognosis

Without therapy, the illness may last for 3 to 4 weeks and death rates range between 12% and 30%.

Even if your symptoms seem to go away, you may still be carrying S. Typhi . If so, the illness could return, or you could pass the disease to other people. In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.

If you are being treated for typhoid fever, it is important to do the following:

Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them. Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance that you will pass the infection on to someone else.

Have your doctor perform a series of stool cultures to ensure that no S. Typhi bacteria remain in your body.

Transmission

Death rates for Typhoid Fever in the U.S. 1906-1960

Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Public education campaigns encouraging people to wash their hands after toileting and before handling food are an important component in controlling spread of the disease. According to statistics from the United States Centers for Disease Control, the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S..

A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others. According to the Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover.

Epidemiology

Locations of typhoid outbreaks worldwide

With an estimated 16-33 million cases of typhoid annually resulting in 500,000 to 600,000 deaths In endemic areas, the World Health Organisation identifies typhoid as a serious public health problem. Its incidence is highest in children between the ages of 5 and 19 years.

In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year. Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan. Therefore, if you are traveling to the developing world, you should consider taking precautions. Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.

Heterozygous advantage

It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. The CFTR protein is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.

References

Further reading

• Gale's Encyclopedia of Medicine, published by Thomas Gale in 1999, ISBN

External links

• "www.netdoctor.co.uk". Article on typhoid fever for travelers. Retrieved 17 december.
• United States Center for Disease Control and Prevention Listing
• Harrison, Noel G. (2007). "www.healthsystem.virginia.edu". Historical exhibit on efforts by US Army to control typhoid fever.
• "www.medicalnewstoday.com". Article on typhoid fever and the fall of Athens.
• http://wwwn.cdc.gov/travel/yellowBookCh4-Typhoid.aspx
• http://www.cdc.gov/ncidod/diseases/submenus/sub_typhoid.htm

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