Typhoid Fever

Typhoid Fever插图

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Medically Reviewed byCarol DerSarkissian, MD

What Are the Symptoms of Typhoid Fever?

Typhoid fever is an acute illness associated with fever caused by theSalmonella enterica serotype Typhibacteria. It can also be caused bySalmonellaparatyphi, a related bacterium that usually causes 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.

The incidence of typhoid fever in the United States has markedly decreased since the early 1900s, when tens of thousands of cases were reported in the U.S. Today, less than 400 cases are reported annually in the United States, mostly in people who have recently traveled to Mexico and South America. This improvement is the result of better environmental sanitation. India, Pakistan, and Egypt are also known as high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease.

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People 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. The bacteria can survive for weeks in water or dried sewage.

About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized. These people may become long-term carriers of the bacteria — even though they have no symptoms — and be the source of new outbreaks of typhoid fever for many years.

After the ingestion of contaminated food or water, theSalmonellabacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by whiteblood cellsin theliver,spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade thegallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into theintestinal tractand can be identified in stool samples. If a test result isnt clear,bloodor urine samples will be taken to make a diagnosis.

The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks. Symptoms include:

Chest congestion develops in many people, andabdominal painand discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of people have recurrent symptoms after feeling better for one to two weeks. Relapses are actually more common in individuals treated withantibiotics.

Typhoid fever is treated withantibioticswhich kill theSalmonellabacteria. 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%. With appropriate 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 side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics is guided by identifying the geographic region where the infection was contracted (certain strains from South America show a significant resistance to some antibiotics.) If relapses occur, patients are retreated with antibiotics.

Those who become chronically ill (about 3%-5% of those infected), can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will provide a cure.

For those traveling to high-risk areas, vaccines are now available.

Typhoid fever is contracted by the ingestion of contaminated food or water.

Diagnosis of typhoid fever is made when

bacteria are detected with stool, urine, or blood cultures.

Typhoid fever is treated with antibiotics.

Typhoid fever symptoms are poor appetite,headaches, generalized aches and pains, fever, and lethargy.

Approximately 3%-5% of patients become carriers of the bacteria after the acute illness.

SOURCE: Centers for Disease Control.

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