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Typhoid fever is an infection that causes
and a . It is most commonly due to a type of bacterium called Salmonella typhi (S. typhi).S. typhi is spread through contaminated food, drink, or water. If you eat or drink something that is contaminated with the bacteria, the bacteria enter your body. They travel into your intestines, and then into your blood. The bacteria travel through the blood to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.Some persons become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.Typhoid fever is common in developing countries. Fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.Early symptoms include , general ill-feeling, and . High fever (103°F, or 39.5°C) or higher and severe diarrhea occur as the disease gets worse.Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.Other symptoms that occur include:ChillsDifficulty paying attention (attention deficit)Fluctuating moodHallucinationsNosebleedsSevere fatigueSlow, sluggish,
feelingWeakness A
(CBC) will show a high number of white blood cells.A
during the first week of the fever can show S. typhi bacteria.Other tests that can help diagnose this condition include: urine test to look for the bacteria that cause Typhoid feverFluorescent
study to look for substances that are specific to Typhoid bacteria (platelet count may be low)Fluids and
may be given by IV (into a vein). Or you may be asked to drink uncontaminated water with electrolyte packets.Antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.Symptoms may return if the treatment has not completely cured the infection.Intestinal hemorrhage (severe )
Intestinal perforation
Call your health care provider if:You have had any known exposure to typhoid feverYou have been in an
area and you develop symptoms of typhoid feverYou have had typhoid fever and the symptoms returnYou develop severe abdominal pain, , or other new symptomsA vaccine is recommended for travel outside of the U.S. to places where there is typhoid fever. The Centers for Disease Control and Prevention website has information about where typhoid fever is common. Ask your health care provider if you should bring electrolyte packets in case you get sick.When traveling, drink only boiled or bottled water and eat well-cooked food. Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.Enteric feverGiannella Ra. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders E 2010:chap 107.Lima AAM, Guerrant RL. Inflammatory enteritides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchill L 2009:chap 97.Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical S Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
MedlinePlus TopicsImagesRead MoreA.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's
is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s ,
and . A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright , A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.The Pensacola journal ( September 17, 1905 )From Wikipedia, the free encyclopedia
This article is about typhoid fever.
For a disease with a similar name, see .
For a related disease which is caused by two different bacteria, see .
Typhoid fever — also known simply as typhoid — is a common worldwide bacterial disease transmitted by the ingestion of food or water contaminated with the
of an infected person, which contain the bacterium ,
The disease has received various names, such as gastric fever, enteric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever and pythogenic fever. The name typhoid means "resembling " and comes from the neuropsychiatric symptoms common to typhoid and typhus. Despite this similarity of their names, typhoid fever and typhus are distinct diseases and are caused by different species of bacteria.
The occurrence of this disease fell sharply in the developed world with the rise of 20th-century sanitation techniques and .
Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. Over the course of these stages, the patient becomes exhausted and emaciated.
In the first week, the temperature rises slowly, and fever fluctuations are seen with relative
(), , headache, and cough. A bloody nose () is seen in a quarter of cases, and abdominal pain is also possible. A decrease in the number of circulating white blood cells () occurs blood cultures are positive for
typhi or S. paratyphi. The
is negative in the first week.[]
In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation or Faget sign), classically with a
is frequent, often calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever".
appear on the lower chest and abdomen in around a third of patients.
are heard in lung bases.
The abdomen is distended and painful in the right lower quadrant, where
can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green, comparable to pea soup, with a characteristic smell. However, constipation is also frequent. The spleen and liver are enlarged () and tender, and liver
are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage.
(The major symptom of this fever is that the fever usually rises in the afternoon up to the first and second week.)
In the third week of typhoid fever, a number of complications can occur:
due to bl this can be very serious, but is usually not fatal.
Intestinal perforation in the distal : this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until
or diffuse
Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects.
Metastatic abscesses, , , and
The fever is still very high and oscillates very little over 24 hours.
ensues, and the patient is delirious (typhoid state). One-third of affected individuals develop a macular rash on the trunk.
Platelet count goes down slowly and risk of bleeding rises.
By the end of third week, the fever starts subsiding (). This carries on into the fourth and final week.
A 1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a
The bacterium that causes typhoid fever may be spread through poor hygiene habits and public sanitation conditions, and sometimes also by flying insects feeding on feces. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. According to statistics from the United States
(CDC), the
of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S.A.
Diagnosis is made by any ,
and with the Widal test (demonstration of Salmonella
and ). In epidemics and less wealthy countries, after excluding , , or , a therapeutic trial time with
is generally undertaken while awaiting the results of the Widal test and cultures of the blood and stool.
The Widal test is time-consuming, and often, when a diagnosis is reached, it is too late to start an
The term 'enteric fever' is a collective term that refers to severe typhoid and paratyphoid.
Main article:
Doctor administering a typhoid
at a school in , 1943
Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals, so transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to prevent typhoid.
Two vaccines are licensed for use for the prevention of typhoid: the live, oral
vaccine (sold as Vivotif by Crucell Switzerland AG) and the injectable
(sold as Typhim Vi by Sanofi Pasteur and 'Typherix by GlaxoSmithKline). Both are 50 to 80% protective and are recommended for travellers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form. An older, killed-whole-cell vaccine is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection).
The rediscovery of
in the 1960s provided a simple way to prevent many of the deaths of
diseases in general.
Where resistance is uncommon, the treatment of choice is a
such as . Otherwise, a third-generation cephalosporin such as
is the first choice.
is a suitable oral alternative.
Typhoid fever, when properly treated, is not fatal in most cases. , such as , chloramphenicol, , , and ciprofloxacin, have been commonly used to treat typhoid fever in microbiology. Treatment of the disease with antibiotics reduces the case-fatality rate to about 1%.
When untreated, typhoid fever persists for three weeks to a month. Death occurs in 10% to 30% of untreated cases. In some communities, however, case-fatality rates may reach as high as 47%.[]
Surgery is usually indicated in cases of . Most surgeons prefer simple closure of the perforation with drainage of the . Small-bowel resection is indicated for patients with multiple perforations.
If antibiotic treatment fails to eradicate the
carriage, the
should be resected.
is not always successful in eradicating the carrier state because of persisting hepatic infection.
Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and
is now common, and these agents have not been used as first–line treatment for almost 20 years.[] Typhoid resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).
Ciprofloxacin resistance is an increasing problem, especially in the
and . Many centres are therefore moving away from using ciprofloxacin as the first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand, or Vietnam. For these patients, the recommended first-line treatment is . Also,
has been suggested to be better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. Azithromycin significantly reduces relapse rates compared with ceftriaxone.
A separate problem exists with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against
(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 ( 0.125–1.0 mg/l) would not be picked up by this method. It is not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent on
and cannot test for MICs.
of typhoid fever
? Strongly
? Endemic
? Sporadic cases
In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths. Its incidence is highest in children and young adults between 5 and 19 years old. These cases as of 2010 caused about 190,000 deaths, up from 137,000 in 1990. Infants, children, and adolescents in south-central and Southeast Asia experience the greatest burden of illness. Nonetheless, outbreaks of typhoid fever are frequently reported from sub-Saharan Africa and countries in Southeast Asia. Historically, in the pre-antibiotic era, the
of typhoid fever was 10–20%. Today, with prompt treatment, it is less than 1%. However, about 3-5% of individuals who are infected will develop a chronic infection in the gall bladder. Since Typhi is human-restricted, these chronic carriers become the crucial reservoir, which can persist for decades for further spread of the disease, further complicating the identification and treatment of the disease. Lately, the study of Typhi associated with a large outbreak and a carrier at the genome level provides new insights into the pathogenesis of the pathogen.
Around 430–424 BC, a devastating , which some believe to have been typhoid fever, killed one-third of the population of , including their leader . The balance of power shifted from Athens to , ending the
that had marked Athenian dominance in the Greek ancient world. The ancient historian
also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak and modern academics and medical scientists consider
the most likely cause. In 2006, a study detected
sequences similar to those of the bacterium responsible for typhoid fever in
extracted from a burial pit dated to the time of the outbreak.
("Typhoid Mary") in a hospital bed (foreground): She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until her death in 1938.
The cause of the plague has long been disputed and other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. The disease is most commonly transmitted through poor hygiene habits and public s during the period in question, the whole population of
was besieged within the
and lived in tents.
Some historians believe the English colony of , died out from typhoid. Typhoid fever killed more than 6000 settlers between 1607 and 1624.
During the , 81,360 Union soldiers died of typhoid or . In the late 19th century, the
averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 people.
exposed American troops to typhoid fever overseas and also in stateside training camps. The Surgeon General of the Army, , suggested that the War Department create a Typhoid Fever Board. Major , Edward O. Shakespeare, and Victor C. Vaughan were appointed August 18, 1898, with Reed being designated the President of the Board. The Typhoid Board determined that during the war, more soldiers died from this disease than from yellow fever or from battle wounds. The Board promoted sanitary measures including latrine policy, disinfection, camp relocation, and water sterilization, but by far the most successful antityphoid method was vaccination, which became compulsory in June 1911 for all federal troops.
The most notorious carrier of typhoid fever, but by no means the most destructive, was , also known as Typhoid Mary. In 1907, she became the first carrier in the United States to be identified and traced. She was a cook in . She is closely associated with 53 cases and three deaths. Public health authorities told Mary to give up working as a cook or have her
removed. Mary quit her job, but returned later under a . She was detained and
after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.
During the course of treatment of a typhoid outbreak in a local village in 1838, English country doctor
realised the "poisons" involved in
multiplied in the intestines of the sick, were present in their excretions, and could then be transmitted to the healthy through their consumption of contaminated water. He proposed strict isolation as a method for containing such outbreaks in the future. The medical and scientific communities did not identify the role of microorganisms in infectious disease until the work of .
developed the first effective typhoid vaccine.
described a bacillus that he suspected was the cause of typhoid. In 1884, pathologist
() confirmed Eberth's findings, and the organism was given names such as Eberth's bacillus, Eberthella typhi, and Gaffky-Eberth bacillus. Today, the bacillus that causes typhoid fever goes by the scientific name , serovar Typhi.
The British bacteriologist
first developed an effective typhoid vaccine at the Army Medical School in , . It was introduced in 1896 and used successfully during the . At that time, typhoid often killed more soldiers at war than were lost due to enemy combat. He further developed his vaccine at a newly opened research department at
Medical School in London from 1902, where he established a method for measuring protective substances () in human blood.
Citing the example of the , during which many soldiers died from easily preventable diseases, Wright convinced the
that 10 million vaccines should be produced for the troops being sent to the , thereby saving up to half a million lives during . The British Army was the only combatant at the outbreak of the war to be fully immunized against the bacterium, which meant that for the first time, casualties due to combat exceeded those from disease.
In 1909, , a
physician, adopted Wright's typhoid vaccine for use with the , and two years later, his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military.
was a child inmate in a British-run concentration camp in South Africa who died from typhoid fever during the
Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. In 1908, the chlorination of drinking water was a significant step in the control of typhoid fever in the U.S. The first permanent disinfection of drinking water in the U.S. occurred on the , water supply. Credit for the decision to build the chlorination system has been given to
facility was designed by . Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. Today, the incidence of typhoid fever in developed countries is around five cases per million people per year.
occurred in , , in 1964. This was due to contaminated tinned meat sold at the city's branch of the
chain of stores. No fatalities resulted.
An outbreak in the
in 2004–05 recorded more than 42,000 cases and 214 deaths.
, one of the
died of typhoid fever in 1793.
In memory of , who died of typhoid in 1884, his parents founded .
, English poet, died of typhoid fever in 1889.
, husband of , died of typhoid fever at the age of 42.
Major , who fought in the , depicted in the film , died of typhoid fever in India in 1891.
, captain of the 1886 Australian cricket team that toured England, died of typhoid in 1910.
, the older of the two Wright Brothers, died of typhoid on May 30, 1912.
, a British scientist, died of typhoid in 1915. She acquired the disease while preparing vaccinations for WWI troops, despite the protection of having been vaccinated herself.
, English novelist, died in 1932 of typhoid, two months after drinking a glass of water in a Paris hotel to prove it was safe.
, Japanese medical scientist, died of typhoid fever in 1934.
, Chinese musician, died of typhoid fever in 1938.
Mary Mallon, "Typhoid Mary", presumed to have infected 51 people over her career as a cook, died in 1938.
acquired typhoid on a 2010 trip to , but survived.
, author of , acquired typhoid while being a nurse at a hospital in , but survived.
Gen. , general in the Mexican army in charge of the
on , died on September 8, 1862, shortly after his victory over the French army, of typhoid fever, at the age of 33.
Abigail Adams, wife of Founding Father and President John Adams and mother of the sixth President John Quincy Adams, died of typhoid fever on October 28, 1818, at the age of 73.
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