Typhoid Fever

Typhoid Fever

Kirsten MuellerAP BiologyPeriod 4/5

What is Typhoid Fever?

Typhoid Fever is a life-threatening illness caused by the bacterium Salmonella Typhi.

Typhoid Fever is also known as enteric fever, bilious fever or Yellow Jack.

It is a gram-negative short bacillus that is motile due its flagellum. Gram-negative bacteria are

pathogenic, meaning they can cause disease in a host organism.

Typhoid Fever

About 400 cases of Typhoid Fever occur each year in the United States.

70% of these cases are acquired while traveling internationally.

Typhoid Fever affects approximately 12.5 million people each year.

Typhoid Fever

According to the doctor-produced website of www.MedicineNet.com, patients with acute illness can contaminate the surrounding water supply through their feces which has a very high concentration of the bacteria.

After the acute, illness about 3%-5% of the people become carriers of the disease. Sometimes the illness goes unnoticed but these people become long-term carriers.

The bacteria will multiply while in the gallbladder, bile ducts and the liver and then pass into the bowel.

The Disease

After ingested, the bacteria temporarily enter the blood stream and travel to the small intestine.

White blood cells carry the disease to the liver, spleen and bone marrow where it reproduces and reenters the blood stream.

The bacteria then invades the gallbladder, biliary system, and the lymphatic tissue of the bowel.

Typhoid Nodule in the liver

Affected Organs

Abdominal Cavity including: Liver Gallbladder Stomach Small intestine Large intestine

How is Typhoid Fever Contracted?

Typhoid Fever is contracted by the ingestion of the bacteria in contaminated food or water.

The bacteria itself only lives in humans and is carried through the blood stream and intestinal tract.

Both ill people and carriers of the disease spread the Typhoid bacteria through their feces.

Transmission

Typhoid can be passed through animals, only through humans.

Flies however, are known to help transmit the disease because when they land on human excrement, it remains on their appendages and can be transmitted when they land on something else.

International History of Typhoid Fever Around 430-426 B.C. it is

believed that Typhoid Fever killed 1/3 of the population in Athens.

This was long disputed but after a DNA discovery in 2006, it was determined that it was the Typhoid Fever bacterium.

Between 2004-2005 an outbreak in the Dominican Republic occurred with 42,000 cases and 214 deaths.

National History of Typhoid Fever

In the late 19th century, a typhoid fever outbreak in Chicago occurred killing 65 per 100,000 people.

In 1891, the worst mortality rates were 174 per 100,000 people.

In 1907, the first American carrier was discovered - Mary Mallon aka Typhoid Mary.

United States

According to statistics from the Centers for Disease Control have proved that the chlorination of drinking water has led to a decrease in the transmission of typhoid fever in the United States.

Where in the World?

Typhoid Fever is very common around the world except in industrialized nations such as the United States, Canada and Japan.

Symptoms

Symptoms include: Fevers up to 103° or 104° Weakness Headaches Poor appetite Generalized aches and

pains Diarrhea Occasionally a rash of flat,

rose-colored spots Discomfort Abdominal Tenderness

Typhoid Fever Rash

Symptoms Continued

Constipation, then diarrhea

Bloody Stools Nosebleed Chills Delirium Confusion Agitation Fluctuating moods Hallucinations

Stages of Typhoid Fever

Classically, the untreated typhoid fever is broken down into four different stages, each lasting about a week.

Stage One: A slowly rising temperature Relative bradycardia

(unusually slow heart rate), malaise (discomfort or uneasiness), headache and cough.

In ¼ of cases, epistaxis (acute hemorrhage from the nostril, nasal cavity, or nasopharynx) can occur.

Stages of Typhoid Fever

Stage Two: Continuing high fever Extremely distended

abdomen Considerable weight loss Bradycardia continues Dicrotic pulse wave Delirium is frequent,

frequently calm and sometimes agitated.

Stages of Typhoid Fever

Stage Three: A number of complications can

occur: Intestinal hemorrhage due to

bleeding Intestinal perforation Encephalitis (inflammation of

the brain) Fever is still very high Dehydration occurs and

increases delirium Lies motionless with eyes half-

opened Stage Four:

Defervescence (very high fever) commences that continues into the fourth week.

Complications

Death occurred from the development of other complications such as: Overwhelming infections Pneumonia Intestinal bleeding Intestinal perforation Kidney Failure Peritonitis (inflammation of the

peritoneum, the thin membrane that lines the abdominal wall and covers most of the organs of the body)

Complications Continued

Inflammation of the pancreas

Infections of the spine Inflammation of the

membranes surrounding the spinal cord and brain (meningitis)

Inflammation of the heart muscle

Psychiatric problems

Diagnosis

Diagnosis is made by blood, bone marrow, or stool.

The Widal test is commonly used to diagnose Typhoid. Looks for salmonella

antibodies against antigens O-somatic and H-flagellar)

Exams and Tests An elevated white blood cell

count A blood culture the shows

the bacteria A stool culture An ELISA test to show the

Vi antigen A platelet count (low platelet

count) A fluorescent antibody study

Antibody Testing

Fluorescent Antibody Test

The test checks for the antibody specific to the S. Typhi bacterium.

Antigen Testing

Enzyme-linked immunosorbent assay (ELISA)

The blood test looks for the antigen specific to the typhoid bacteria.

Carriers of Typhoid

3%-5% of people who have been infected become carriers of the disease.

Carriers are treated with prolonged antibiotics.

Removal of the gallbladder or the site of the infection will usually cure the patient.

Typhoid Carrier undergoes treatment

Carriers of Typhoid Fever

A carrier is usually a healthy person who survived the disease but in whom the bacteria are able to survive without causing further symptoms.

Carriers continue to spread the disease through their excrement without realizing it.

It is believed that Mary Mallon never actually had the disease however, her mother had typhoid while pregnant with her.

Typhoid Mary She infected 47 people and

killed 3 She constantly changed her

employment but the members of the household always got sick.

She was forced into containment for two years and then released under the conditions that she could no longer be a cook.

She assumed a false name and began cooking again and of course, infecting numerous people.

She was forced into life-time containment where she died 26 years later of pneumonia.

Famous People with Typhoid Fever Abigail Adams, wife of

President John Adams Martha Bulloch, mother of

Theodore Roosevelt Stephan A. Douglas Wilbur Wright William Wallace Lincoln,

son of Abraham Lincoln Archduke Karl Ludwig of

Austria

More Famous People

Albert of Saxe-Coburg-Gotha, British prince consort, Queen Victoria’s husband

Henry Frederick, Prince of Wales, original heir ot the throne of James I of England

Mark Hanna, US politician

Heterozygous Advantage

Those with cystic fibrosis are believed to have a natural resistance to Typhoid Fever.

The CFTR protein is present in both the lungs and the intestinal tract. The mutated protein in CF prevents entry of the typhoid bacteria into the body through these membrane.

Treatment

Typhoid is treated with an antibiotic that kills the Salmonella bacteria.

With antibiotics, improvement can be seen in 1-2 days and recovery in 7-10 days.

Intravenous fluids and electrolytes may also be given to patients.

Typhoid Vaccine

Treatment

In most cases typhoid fever is not fatal.

Antibiotics such as ampicillin, chloramphenicol, trimethethoprim-sulfamethoxazole, and ciprofloxican.

These antibiotics have been used in most developed countries.

Resistance

Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin are common drugs used against Typhoid but have now become resistant.

These drugs have not been used in over 20 years.

Typhoid that is resistant to multiple drugs is known as multidrug-resistant typhoid (MDR typhoid).

Chloramphenicol

Chloramphenicol was the original prescribed drug to patients with Typhoid Fever.

However due to certain side effects, this drug has been replaced by others. Chloramphenicol

Choice of Drugs

The type of antibiotic prescribed is based on the region in which the disease originates.

Bacteria from certain areas in South America show a resistivity to many antibiotics.

Relapses of the disease are dealt with by the administration of antibiotics.

Improvement With the use of

antibiotics, improvement can come usually in the fourth week.

The fever generally decreases back down to normal temperature in 7-10 days.

Signs and symptoms however, can return in up to 2 weeks after the fever has subsided.

Fatality

Before the antibiotic, the death rate was 20%.

Antibiotics have reduced the fatality rate 1%-2%.

Antibiotic to prevent Typhoid Fever

How can Typhoid be avoided? Avoid risky foods or drinks Get vaccinated Use only clean water Ask for drinks without ice

unless you know where it’s coming from

Only eat foods that have been thoroughly cooked

Avoid raw fruits and vegetables

Avoid food and drinks from street vendors

Attention Travelers!

Vaccines are now available to those who are traveling abroad to underdeveloped countries.

Who should get the Typhoid Vaccine?

Travelers to parts of the world where Typhoid Fever is very common.

People who work with or come in contact with a carrier of the disease.

Laboratory analysts who work with the Salmonella Typhi bacteria.

Vaccinations

The vaccine was discovered in 1897 by Almroth Edward Wright.

There are two types of vaccinations available: Inactive (killed) vaccine in a

shot (Vi capsular polysaccharide vaccine)

Live, attenuated (weakened) vaccine taken orally (Ty21a)

Typhoid Vaccination

VaccinationShot

Administered at least 2 weeks before traveling.

Vaccination only lasts 2 years so booster shots are needed for those still at risk.

Not for children under 2 years of age.

VaccinationOral

Not for children under the age of 6.

4 administrations, each given 2 days apart.

Last administration should be given at least a week before traveling.

A booster shot is needed every 5 years.

Vaccinations

Vaccine Name How given Number of

doses necessary

Time between doses

Total time needed to set aside

for vaccinatio

n

Minimum age for

vaccination

Booster needed every...

Ty21a (Vivotif Berna, Swiss Serum

and Vaccine

Institute)

1 capsule by mouth

4 2 days 2 weeks 6 years 5 years

ViCPS (Typhim

Vi, Pasteur

Merieux)

Injection 1 N/A 2 weeks 2 years 2 years

Risks of the VaccinationShot

Fever (1 per 100 people)

Headache (3 per 100 people)

Redness or swelling at the site of injection (7 per 100 people)

Risks of VaccinationOral

Fever (5 per 100 people)

Headache (5 per 100 people)

Abdominal discomfort, nausea, vomiting or rash are very rare

Reactions to Vaccination

Allergic reactions can be a result of the vaccination.

If a severe reaction occurs such as:Difficulty breathingHoarsenessWheezingHivesPalenessWeaknessIncreased heart rateDizzinessCall a doctor or seek medical treatment immediately

Video

http://www.youtube.com/watch?v=mQunnRZOzJ8&feature=related

www.youtube.com/watch?v=vQPrSRSVfIM

Sources

www.MedicineNet.com http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfeve

r_g.htm Dr. Adrian Popp, M.D. from the Long Island Infectious

Disease Associates, P.C. www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.ht

m http://en.wikipedia.org/wiki/Typhoid_fever www.mayoclinic.com/health/typhoid-fever/DS00538/DSE

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