Typhoid fever or tipus is a common illness in the Philippines and is commonly caused by ingesting contaminated food or water.

The most common sources of contamination are human stool and chicken stool. Like other common diseases and illnesses in the Philippines during the rainy season, the best way to prevent typhoid fever is to make sure that the food and water that you take in are clean. According to wikipedia, Typhoid fever also known as enteric fever, or commonly just typhoid, is an illness caused by the bacterium Salmonella enterica serovar Typhi. Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. Salmonella Typhi then alters its structure to resist destruction and allow them to exist within the macrophage. This renders them resistant to damage by PMNs, complement and the immune response. The organism is then spread via the lymphatics while inside the macrophages. This gives them access to the reticuloendothelial system and then to the different organs throughout the body. The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacteria grows best at 37 C/99 F human body temperature. According to the record of the Department of Health (DOH), the highest number of confirmed cases of typhoid fever outbreak was in Laguna with 400 cases and 7 deaths. Prevention of typhoid fever include, but is not limited to, the following: 1. Frequent handwashing with antibacterial soap 2. Environmental sanitation especially proper waste disposal 3. Boiling of unsanitary water for at least 2 minutes

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache, and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopeniaand relative lymphocytosis, a positive reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test 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), classically with a dicrotic pulse wave.

Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and there is elevation of liver transaminases.

The Widal reaction 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: Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal. Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in. Encephalitis Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects. Metastatic abscesses, cholecystitis, endocarditis and osteitis

The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing this (defervescence). This carries on into the fourth and final week. What is the incubation period for typhoid fever? 3 days to 3 months. Most typically 1 to 3 weeks.

How many US cases of typhoid fever were reported in 1998? 324. It is transmitted by food or water contaminated by feces or urine of patients or carriers, oysters harvested from fecally contaminated waters, fecally contaminated fruits and raw vegetables, and from feces to food by flies.

What was Mary Mallon, a New York cook and infamous carrier of typhoid fever during the early 1900s, more commonly known as? Typhoid Mary. She was responsible for a number of outbreaks of typhoid fever and 3 deaths because she refused to have a gall bladder operation to eliminate the pathogens and refused to change her profession. She was finally confined to a hospital to prevent her from causing further cases. Mary Mallon died in 1938 at the age of 70.

Typhoid fever is more common in the tropics. It tends to occur in places where the sanitation standards are poor. Typhoid fever is caused by a bacterial organism called salmonella typhi. Salmonella paratyphi can also cause fever and abdominal symptoms. The disease caused by both these entities is called enteric fever. The disease presents with a typical, continuous fever for about three to four weeks, relative bradycardia with abdominal pain (due to enlargement of lymph nodes in the abdomen), and constipation.

Geographical distribution
Worldwide, typhoid fever affects about six million people with more than 600,000 deaths a year. Almost 80% of cases and deaths occur in Asia, and most others in Africa and Latin America. Among Asian countries, India probably has a large number of these cases.

Indian statistics
Typhoid fever is endemic in India. Health surveys conducted by the Central Ministry of Health in the community development areas indicated a morbidity rate varying from 102 to 2219 per 1,00,000 population in different parts of the country. A limited study in an urban slum showed 1% of children up to 17 years of age suffer from typhoid fever every year.

Carriers of typhoid fever

Typhoid infection is mainly acquired from persons who are carriers of the disease. Carriers are people who continue to excrete salmonella through their urine and feces a year after an attack of typhoid. A chronic carrier state develops in about 2 to 5% of the cases. The organisms in such cases make the gall bladder their habitat. Typhoid fever is passed from person to person through poor hygiene, such as incomplete or no hand washing after using the toilet. Persons who are carriers of the disease and who handle food can be the source of epidemic spread of typhoid. One such individual gave her name to the expression "Typhoid Mary," a name given to someone whom others avoid. Typhoid fever is a particularly difficult problem in parts of the world with poor sanitation practices. There are about 16 million cases of typhoid reported around the world each year. In the United States, most patients who contract typhoid fever have recently returned from travel to another country where typhoid is much more common, including Mexico, Peru, Chile, India, and Pakistan. However, there have been reports in the early 2000s of typhoid outbreaks within the United States that were unrelated to recent travel. One such outbreak occurred in Queens, New York, and was traced to a worker in a local restaurant. After being swallowed, the S. typhi bacteria head down the digestive tract, where they are taken in by cells called mononuclear phagocytes. These phagocytes are cells of the immune system, whose job it is to engulf and kill invading bacteria and viruses. In the case of S. typhi, however, the bacteria are able to survive ingestion by the phagocytes, and multiply within these cells. This period of time, during which the bacteria are multiplying within the phagocytes, is the 10 to 14-day incubation period of typhoid fever. When huge numbers of bacteria fill an individual phagocyte, they spill out of the cell and into the bloodstream, where their presence begins to cause symptoms. The presence of increasingly large numbers of bacteria in the bloodstream (bacteremia ) is responsible for an increasingly high fever, which lasts throughout the four to eight weeks of the disease in untreated individuals. Other symptoms of typhoid fever include constipation (at first), extreme fatigue, headache,joint pain, and a rash across the abdomen known as rose spots. The bacteria move from the bloodstream into certain tissues of the body, including the gallbladder and lymph tissue of the intestine (called Peyer's patches). The tissue's response to this invasion causes symptoms ranging from inflammation of the gallbladder (cholecystitis ) to intestinal bleeding to actual perforation of the intestine. Perforation of the intestine refers to an actual hole occurring in the wall of the intestine, with leakage of intestinal contents into the abdominal cavity. This leakage causes severe

irritation and inflammation of the lining of the abdominal cavity, which is called peritonitis. Peritonitis is a frequent cause of death from typhoid fever. Other complications of typhoid fever include liver and spleen enlargement, sometimes so great that the spleen ruptures or bursts; anemia, or low red blood cell count due to blood loss from the intestinal bleeding; joint infections, which are especially common in patients with sickle cell anemia and immune system disorders; pneumonia caused by a bacterial infectionusually Streptococcus pneumoniae which is able to take hold due to the patient's weakened state; heart infections; and meningitis and infections of the brain, which cause mental confusion and even coma. It may take a patient several months to recover fully from untreated typhoid fever.

KEY TERMS Asymptomatic A state in which a person experiences no symptoms of a disease. Bacteremia Bacteria in the blood. Carrier A person who has a particular disease agent present within his/her body, and can pass this agent on to others, but who displays no symptoms of infection. Epidemic A large number of cases of the same disease or infection all occurring within a short time period in a specific location. Mononuclear phagocyte A type of cell of the human immune system that ingests bacteria, viruses, and other foreign matter, thus removing potentially harmful substances from the bloodstream. These substances are usually then digested within the phagocyte. Rose spots A pinkish rash across the trunk or abdomen that is a classic sign of typhoid fever. Resources

Typhoid Fever Facts on Symptoms

When a person becomes infected with the bacteria that cause typhoid fever, the bacteria begin to multiply and spread into the bloodstream. After 3 to 60 days, symptoms of typhoid fever can occur. This period between becoming infected and the start of symptoms is the typhoid fever incubation period.

Typhoid Fever Facts on Carriers

Approximately 3 to 5 percent of people may still carry the typhoid fever bacteria, even if symptoms go away with treatment. In carriers, it is possible for the illness to return or be passed on to other people. These people are known as typhoid fever carriers. The most famous typhoid fever carrier was Mary Mallon, the infamous Typhoid Mary.

The Facts on Typhoid Typhoid, also known as typhoid fever or enteric fever, is an infection caused by the bacteria Salmonella typhi. Across the world, millions of people are infected annually by typhoid, and about 200,000 of them die. The number of people infected with typhoid each year is very low in North American and the industrialized world; typhoid is common in developing countries. Typhoid is usually curable, but some bacterial strains are becoming increasingly resistant to antibiotics. Most people with typhoid in North America acquire it while travelling to developing areas of the world.

If untreated, about 10% to 16% of people with typhoid will die. This drops to less than 1%when people are treated promptly. About 3% of infected people, whether treated or not, become asymptomatic carriers of Salmonella typhi. This means that they continue to shed bacteria in their feces for at least a year and often for life but don't have any symptoms of typhoid. There are a small number of typhoid carriers in every country. Even Canada and the United States report dozens of locally transmitted cases of typhoid each year, though most cases in these countries are among travellers or people immigrating who are ill when they arrive. Other complications of typhoid occur when a large number of bacteria get into the bloodstream, causing bacteremia. They can travel to the lungs, causing pneumonia, or to the lining of the brain (meningitis), the bones (osteomyelitis), the heart valves (endocarditis), the kidneys (glomerulitis), the genital or urinary tract, or the muscles.Hepatitis (inflammation of the liver) can also occur. Typhoid fever can be acquired almost anywhere in the world, but it is very rare in developed countries. You have a higher risk of getting typhoid fever if you travel to developing areas such as Asia, Africa, and Latin America. Preventing typhoid is all about avoiding contaminated food and water. The same healthy practices will also help protect you from diseases such as cholera and hepatitis A, which are transmitted in the same way. Follow these guidelines to minimize your risk:
Boil or disinfect all water before drinking it - use disinfectant tablets or liquid available in pharmacies or drink commercially bottled (preferably carbonated) beverages. Peel all fruit and vegetable skins before eating. Keep flies away from food. Watch out for ice cubes, ice cream, and unpasteurized milk, which can easily be contaminated. Cook all food thoroughly and eat it while it's hot. Be aware of the "danger foods" - shellfish, salads, and raw fruit and vegetables. Do not eat food or drink beverages from street vendors.

Salmonella typhi