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Typhoid: Typhoid Fever
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Typhoid fever is a disease caused by the typhoid bacillus, Salmonella typhi. It is spread through contaminated food and water or by close contact with an infected person. It occurs worldwide, and while uncommon in the United States, cases are reported every year, especially from travelers. The highest disease rates occur in Chile, Peru, India, Pakistan, Indonesia, Nigeria, and North Africa, and other countries where difficulties in sanitation and unprotected water supplies exist. Symptoms may include fever, headache, listlessness and body aches, loss of appetite, and stomach problems often beginning with constipation, followed by serious diarrhea. Symptoms can be severe and prolonged.
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Typhoid Fever is an acute illness associated with fever caused by the Salmonellae Typhi bacteria. The bacteria is deposited in water or food by a human carrier, and is then spread to other people in the area. The incidence of the illness in the United States has markedly decreased since the early 1900'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 ... known high risk areas for developing this disease.
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Typhoid fever was not well understood in the ancient world, probably because its symptoms are not primarily diarrheal, but rather systemic and non-specific. It was only in the mid-19th century that physicians began to distinguish it from typhus and malaria. (8) Sir William Osler’s clinical description remains unsurpassed. Typhoid fever was frequently associated with military campaigns and was a significant cause of death in the American Civil War and Boer War where deaths from typhoid exceeded those from combat. (9) With recognition that fecal contamination of food and water supplies was the main mode of transmission of the illness and measures taken to prevent these (10;11), typhoid fever has been restricted, in industrialized countries, to localized epidemics (12;13) and infections in travelers returning from endemic areas.
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Typhoid fever affects 17 million people worldwide every year, with approximately 600,000 deaths. The number of sporadic cases of typhoid fever has remained relatively constant in the industrialized world, and with the advent of proper sanitary facilities, has been virtually eliminated in many areas. Most cases in developed countries are imported from endemic countries. Strains resistant to chloramphenicol and other recommended antibiotics have become prevalent in several areas of the world. Multidrug resistant strains have been reported from Asia, the Middle East and Latin America.
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Typhoid fever immunization is recommended for all travelers to less-developed countries, especially those in Central and South America, Africa, Southeast Asia, and the Indian subcontinent. The highest risk countries are Peru, India, Pakistan, and Chile. However, about half of all cases of typhoid fever reported in American tourists are acquired from travel to Mexico even though the risk of disease is lower there. Typhoid fever is typically spread person-to-person by food handlers who do not wash their hands adequately after bowel movements. Visitors who stray off the beaten path and eat meals prepared at foodstands or by street vendors are at highest risk. Carefully selecting restaurants with close attention to their sanitation standards can reduce the risk.
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Typhoid fever is caused by Salmonella typhi, the typhoid bacillus. It is characterized by the sudden onset of sustained fever, severe headache, nausea, loss of appetite, constipation or sometimes diarrhoea. Severe forms have been described with mental dullness and meningitis. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy. However, strains resistant to chloramphenicol and other recommended antibiotics (ampicillin, cotrimoxazole and even ciprofloxacin) have become prevalent in several areas of the world. Paratyphoid fever can be caused by any of three serotypes of S. paratyphi A, B and C. It is similar in its symptoms to typhoid fever, but tends to be milder, with a lower fatality rate.
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Typhoid Fever