What is typhoid fever? What is the history of typhoid fever?

Typhoid fever is an acute illness associated with fever that is most often cause d by the Salmonella typhi bacteria. It can also be caused by Salmonella paratyph i, a related bacterium that usually leads to a less severe illness. The bacteria are deposited 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. Worldwide (2010), typhoid fever affects more than 13 million people, with over 5 00,000 patients died of the disease. How do patients get typhoid fever? Typhoid fever is contracted by the ingestion of the bacteria in contaminated foo d or water. Patients with acute illness can contaminate the surrounding water su pply through stool, which contains a high concentration of the bacteria. Contami nation of the water supply can, in turn, taint the food supply. About 3%-5% of p atients become carriers of the bacteria after the acute illness. Some patients s uffer a very mild illness that goes unrecognized. These patients can become long -term carriers of the bacteria. The bacteria multiplies in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks i n 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. How does the bacteria cause disease, and how is it diagnosed? After the ingestion of contaminated food or water, the Salmonella bacteria invad e the small intestine and enter the bloodstream temporarily. The bacteria are ca rried by white blood cells in the liver, spleen, and bone marrow. The bacteria t hen multiply in the cells of these organs and reenter the bloodstream. Patients develop symptoms, including fever, when the organism reenters the bloodstream. B acteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestina l tract and can be identified for diagnosis in cultures from the stool tested in the laboratory. Stool cultures are sensitive in the early and late stages of th e disease but often must be supplemented with blood cultures to make the definit e diagnosis. What are the symptoms of typhoid fever? The incubation period is usually one to two weeks, and the duration of the illne ss is about four to six weeks. The patient experiences poor appetite; abdominal pain; headaches; generalized aches and pains; fever, often up to 104 F; lethargy (usually only if untreated); intestinal bleeding or perforation (after two to three weeks of the disease); diarrhea or constipation. People with typhoid fever usually have a sustained fever as high as 103 F-104 F (39 C-40 C). Chest congestion develops in many patients, and abdominal pain and discomfort ar e common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of patients have recurrent sympt oms (relapse) after feeling better for one to two weeks. Relapses are actually m ore common in individuals treated with antibiotics. What is the treatment for typhoid fever, and what is the prognosis? Typhoid fever is treated with antibiotics that kill the Salmonella bacteria. Pri or to the use of antibiotics, the fatality rate was 20%. Death occurred from ove rwhelming 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 d ays and recovery within seven to 10 days. Several antibiotics are effective for the treatment of typhoid fever. Chloramphe nicol was the original drug of choice for many years. Because of rare serious si de effects, chloramphenicol has been replaced by other effective antibiotics. Th

e choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Cer tain strains from South America show a significant resistance to some antibiotic s.) Ciprofloxacin (Cipro) is the most frequently used drug in the U.S. for nonpr egnant patients. Ceftriaxone (Rocephin), an intramuscular injection medication, is an alternative for pregnant patients. Ampicillin (Omnipen, Polycillin, Princi pen) and trimethoprim-sulfamethoxazole (Bactrim, Septra) are frequently prescrib ed antibiotics although resistance has been reported in recent years. If relapse s occur, patients are retreated with antibiotics. 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 in fection, will cure the carrier state. Can typhoid fever be prevented? For those traveling to high-risk areas, vaccines are now available. The vaccine is usually not recommended in the U.S. There are two forms of the vaccine availa ble an oral and an injectable form. The vaccination needs to be completed at lea st one week prior to travel and, depending on the type of vaccine, only protects from two to five years. The oral vaccine is contraindicated in patients with de pressed immune systems. Details of the vaccination and the vaccine you chose sho uld be discussed with your health-care provider. Clean food and water must be ingested most especially for infants and children w ho are the most susceptible of the disease. Foods must be prepared cleanly and d oubtful sources of potable water must be rejected or not be used for drinking. People (typhoid fever infected) must urinate and defecate in the toilets for pro per disposal of the body s waste materials to prevent food and water contamination . Everyone must clean their environment and surroundings to help prevent the sprea d of the disease.