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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 bacteriaare deposited in water or food by a human carrier and are then spread to

otherpeople in the area. Typhoid fever is rare in industrial countries but continuesto be a

significant public-health issue in developing countries.Worldwide (2010), typhoid feveraffects more than 13 million people, with over 500,000 patients died of the disease.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 multiplies in the gallbladder, bileducts, or liver and passes into the

bowel. The bacteria can survive for weeks in water or dried sewage. These chronic carriers

may have no symptoms and can bethe source of new outbreaks of typhoid fever for many

years.How does the bacteria cause disease, and how is it diagnosed?After the ingestion ofcontaminated food or water, the Salmonella bacteria invade the small intestine and enter the

bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen,

and bone marrow. The bacteria then multiply in the cells of these organs and reenter the

bloodstream. Patientsdevelop symptoms, including fever, when the organism reenters the

bloodstream. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of

thebowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and

can be identified for diagnosis in cultures from the stool tested inthe laboratory. Stool

cultures are sensitive in the early and late stages of the disease but often must be

supplemented with blood cultures to make the definite diagnosis.What are the symptoms of

typhoid fever?The incubation period is usually one to two weeks, and the duration of the

illness 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 are common. The fever becomes constant. Improvement occurs in the third

and fourthweek in those without complications. About 10% of patients have recurrent

symptoms (relapse) after feeling better for one to two weeks. Relapses are actually more

common in individuals treated with antibiotics.What is the treatment for typhoid fever, andwhat is the prognosis?Typhoid fever is treated with antibiotics that kill the Salmonella

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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%. Withappropriate

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 sideeffects, chloramphenicol has been replaced by other effective antibiotics. Th

e choice of antibiotics needs to be guided by identifying the geographic regionwhere 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.The carrier state, which occurs in 3%-

5% of those infected, can be treated withprolonged antibiotics. Often, removal of thegallbladder, the site of chronic infection, will cure the carrier state.Can typhoid fever be

prevented?For those traveling to high-risk areas, vaccines are now available. The vaccineis

usually not recommended in the U.S. There are two forms of the vaccine available an oral

and an injectable form. The vaccination needs to be completed at least one week prior to

travel and, depending on the type of vaccine, only protectsfrom two to five years. The oral

vaccine is contraindicated in patients with depressed immune systems. Details of the

vaccination and the vaccine you chose should be discussed with your health-care

provider.Clean food and water must be ingested most especially for infants and children who

are the most susceptible of the disease. Foods must be prepared cleanly and doubtful 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 proper disposal of the body

s waste materials to prevent food and water contamination.Everyone must clean their

environment and surroundings to help prevent the spread of the disease.