Typhoid Fever

Images for Illustration of Typhoid Fever

• Usually, Salmonellae typhi bacteria cause typhoid fever.
• People contract typhoid fever by ingesting contaminated food or water.
• Diagnosis of typhoid fever is made when the Salmonella bacteria is detected with a stool culture.
• Antibiotics treat typhoid fever.
• Typhoid fever symptoms include:
  • poor appetite,
  • headaches,
  • diarrhea,
  • generalized aches and pains,
  • fever, and
  • lethargy.
• Approximately 3%-5% of patients become carriers of the bacteria after the acute illness.
• For those traveling to high-risk areas, typhoid vaccines are now available
• There are two forms of the vaccine available, an oral and an injectable form.

Typhoid fever is an acute infectious illness associated with fever that is most often caused by the Salmonella typhi bacteria. Salmonella paratyphi, a related bacterium that usually leads to a less severe illness, can also cause typhoid fever. The feces of human carriers of the bacteria may contaminate water or food, and the illness then spreads 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.

The incidence of typhoid fever in the United States has decreased since the early 1900s. In 2014, medical professionals reported approximately 300 cases to the CDC, mostly in people who recently traveled to endemic areas. This is in comparison to the 1920s, when there were over 35,000 reported cases in the U.S., with a 20% fatality rate.

In the early 1900s, a healthy carrier called Typhoid Mary (her real name was Mary Mallon) caused several outbreaks in the New York City area; she was infected, worked as a cook, and consequently spread the disease to others.

A recent outbreak affected refugees in Manus Island, Papua New Guinea.

The decrease in cases in the United States is the result of improved environmental sanitation, vaccination, and treatment with antibiotics. Mexico and South America are the most common areas for U.S. citizens to contract typhoid fever. India, Pakistan, and Egypt are also known high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with over 200,000 patients dying of the disease.

If traveling to endemic areas, you should consult with your health care professional and discuss if you should receive vaccination for typhoid fever.

People contract typhoid fever when they ingest 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 taint the food supply. About 3%-5% of patients become carriers of the bacteria after acute illness. Some patients suffer a very mild illness that goes unrecognized. These patients can become long-term carriers of the bacteria. The bacteria multiply in the gallbladder, bile ducts, or liver and pass into the bowel. The bacteria can survive for weeks in 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.

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. White blood cells carry the bacteria to the liver, spleen, and bone marrow. The bacteria then multiply in the cells of these organs and reenter the bloodstream. Patients develop symptoms, including fever, when the organism reenters the bloodstream.

Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. 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 in the laboratory.

Stool cultures are sensitive in the early and late stages of the disease, but it may be necessary to perform blood cultures to make a definitive diagnosis.

The incubation period is usually 1-2 weeks, and the duration of the illness is about 4-6 weeks.

The patient experiences the following:

• poor appetite;
• abdominal pain and peritonitis;
• headaches;
• generalized aches and pains and weakness;
• high fever, often up to 104 F;
• lethargy (usually only if untreated);
• intestinal bleeding or perforation (after 2-3 weeks of the disease);
• cough;
• 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 fourth weeks in those without complications. About 10% of patients have recurrent symptoms (relapse) after feeling better for 1-2 weeks. Relapses are more common in individuals treated with antibiotics.

Antibiotics that kill the Salmonella bacteria treat typhoid fever. Before the use of antibiotics and intravenous fluids, the fatality rate was 20%. The death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. Antibiotics and supportive care have reduced the mortality rate to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within 7 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, other effective antibiotics have replaced chloramphenicol. The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available. (Certain strains from South America show 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 (Bactrim, Septra) are frequently prescribed antibiotics although resistance has been reported in recent years.

Medical professionals have reported multi-drug resistance and use cultures to guide treatment. If relapses occur, patients retreat with antibiotics.

Prolonged antibiotics can treat the carrier state, which occurs in 3%-5% of those infected. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.

Your primary care doctor can diagnose and treat typhoid fever. Because the disease is very rare in the United States, an infectious disease specialist often assists in the care of the patient with typhoid fever, as well.

Typhoid fever is very contagious and contracted by the ingestion of bacteria in contaminated food or water. Patients with acute illness can contaminate the surrounding water supply through infected stool, which contains a high concentration of the bacteria. It does not spread through the air (by cough) or by touching (assuming there is no fecal exchange or first bacterial ingestion).

For those traveling to high-risk areas, typhoid vaccines are now available. The routine administration of the vaccine is usually not recommended in the U.S. There are two forms of the vaccine available, an oral and an injectable form. People need to complete the vaccination at least 1-2 weeks (depending on the type of vaccine) before travel and, depending on the type of vaccine. The vaccine only protects from 2 to 5 years. The oral vaccine is contraindicated in patients with depressed immune systems. Details of the vaccination and the choice of vaccine should be discussed with a healthcare professional.