What is typhoid?
What is typhoid fever? What is the history of 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 through fecal contamination in water or food by a human carrier and are then spread to other people in the area. Typhoid fever is rare in industrial countries but continues to be a significant public-health issue in developing countries.
The incidence of typhoid fever in the United States has decreased since the early 1900s. Today, approximately 5,700 cases are reported annually in the United States, mostly in people who recently have traveled to endemic areas. This is in comparison to the 1920s, when over 35,000 cases were reported in the U.S. This improvement is the result of improved environmental sanitation. Mexico and South America are the most common areas for U.S. citizens to contract typhoid fever. India, Pakistan, and Egypt are also known high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with over 200,000 patients dying of the disease.
If traveling to endemic areas, you should consult with your health-care professional and discuss if you should receive vaccination for typhoid fever.
How do patients get typhoid fever?
Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water. Patients with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. About 3%-5% of patients become carriers of the bacteria after the acute illness. Some patients suffer a very mild illness that goes unrecognized. These patients can become long-term carriers of the bacteria. The bacteria multiply in the gallbladder, bile ducts, or liver and pass into the bowel. The bacteria can survive for weeks in water or dried sewage. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years.
What are the symptoms for typhoid?
Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease.
Once signs and symptoms do appear, you're likely to experience:
- Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
- Weakness and Fatigue
- Muscle aches
- Dry cough
- Loss of appetite and Weight loss
- Abdominal pain
- Diarrhea or Constipation
- Extremely swollen abdomen
If you don't receive treatment, you may:
- Become delirious
- Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state
In addition, life-threatening complications often develop at this time.
In some people, signs and symptoms may return up to two weeks after the Fever has subsided.
When to see a doctor
See a doctor immediately if you suspect you have typhoid Fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, 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.
If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn't familiar with these areas.
What are the causes for typhoid?
Typhoid fever is caused by virulent bacteria called Salmonella typhi (S. typhi). Although they're related, S. typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, aren't the same.
Fecal-oral transmission route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid fever is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn't washed carefully after using the toilet. You can also become infected by drinking water contaminated with the bacteria.
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.
What are the treatments for typhoid?
Typhoid fever is treated with antibiotics that kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.
Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Certain strains from South America show a significant resistance to some antibiotics.) Ciprofloxacin (Cipro) is the most frequently used drug in the U.S. for nonpregnant patients. Ceftriaxone (Rocephin), an intramuscular injection medication, is an alternative for pregnant patients. Ampicillin (Omnipen, Polycillin, Principen) and trimethoprim-sulfamethoxazole (Bactrim, Septra) are frequently prescribed antibiotics although resistance has been reported in recent years. If relapses occur, patients are retreated with antibiotics.
Learn more about: Cipro | Ceftriaxone | Rocephin | Principen | Bactrim | Septra
The carrier state, which occurs in 3%-5% of those infected, can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.
What are the risk factors for typhoid?
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 26 million or more people each year. The disease is endemic 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 endemic
- 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 contaminated by sewage that contains S. typhi
Is there a cure/medications for typhoid?
Typhoid is an infectious disease that causes fever, also known as enteric fever. The causative agents are salmonella typhi and paratyphi. Typhoid presents non-specific symptoms. It initially starts with nausea and vomiting that progress to abdominal pain, anorexia, and bloating. It is followed by a small asymptomatic phase that leads to a high fever. If left undiagnosed and treated, the abdominal distress worsens and causes bowel perforations and peritonitis. Further severe complications involve the lungs, heart, and liver.
The selection of treatment depends on the severity, duration, dissemination, and complications due to the disease.
- Antibiotics are the primary drugs to treat typhoid. The development of antibiotic resistance has made the therapy complicated. Fluoroquinolones are the most effective antibiotic of choice.
- Ciprofloxacin is the most effective among the fluoroquinolones. Amoxicillin, chloramphenicol, and trimethoprim-sulfamethoxazole are the alternatives.
- In cases with multi-drug resistance, third-generation cephalosporins and Azithromycin are the options. The cephalosporins include ceftriaxone, cefotaxime, and cefixime.
- Uncomplicated cases are treated with oral antibiotics and antipyretics. But patients with severe complications such as vomiting and diarrhea must be hospitalized.
- For symptomatic and supportive treatment, analgesics and antipyretics are prescribed to improve fever, headache, and body ache.
- In severe cases, complications such as ileal perforation and peritonitis require surgical interventions.
- When typhoid is associated with gallstones, cholecystectomy is necessary.
Ciprofloxacin,Amoxicillin,Chloramphenicol,Trimethoprim-sulfamethoxazole,Azithromycin, cephalosporins: ceftriaxone, cefotaxime, and cefixime,Antipyretics,Analgesics,Anti-diarrheal drugs
Fever,Diarrhea,Headache,Abdominal pain,Anorexia,Nausea,Vomiting,In severe cases peritonitis and intestinal perforation