c
 



 However, an autopsy found evidence of livety?
oidbacteria in her
Typhoid fever is a bacterial infection of the intestinal tract and gallbladder. Her body was cremated with burial in Saint Raymond's
occasionally the bloodstream. Cemetery in the Bronx.
Outbreaks are rare. [
  
The germ that causes typhoid is a unique human strain of Systemic bacterial infection (Enteric Fever)
Salmonella called Salmonella typhi. 1. Salmonella typhi (Typhoid fever)

 Most common and more severe form
It is caused by infection with !



 


A bacteria found in infected animals 


 

     Typhoid germs are passed in the „eces and, to some extent, the
c   

 uri e of infected people.



 The germs are spread by eating or drinking water or foods
(September 23, 1869 ʹ November 11, 1938) contaminated by feces from the infected individual.
Also known as   

 r j

was the „irst person in the United States to be identified as a World: ½  cases per year
healthy carrier of typhoid fever. U.S.:  cases per year (70% in travelers)
She seemed a healthy woman when a health inspector knocked on PHILIPPINES
her door in 1907, yet she was the cause of several typhoid (Nov 2006) 478 in Agusan del Sur.
(May 2004) 292 in Bacolod City
outbreaks.





Since Mary was the „irst "healthy carrier" of typhoid fever in the Travel to developing country or refugee camp
United States, she did not understand how someone not sick could Highly dense living conditions
spread disease -- so she tried to fight back. c


 
She was forcibly quarantined twice by public health authorities and The symptoms may occur rapidly, particularly in children. However,
died in quarantine. in adults, they usually come on slowly
Over the course of her career as a cook, she infected 47 people, ela?sesarecommo 
three of whom died from the disease. Fatalities are less than 1% with antibiotic treatment.
It was also possible that she was born with the disease, as her Symptoms generally appear one to three weeks after exposure.
mother had typhoid fever during her pregnancy.
!
 Incubation (first 7-14 days after ingestion)
MaryMallon died on November 11, 1938 at the age of 69 due to Gsuallyasym?tomatic
? eumo ia (not typhoid), six years after a stroke had left her Diarrhea may occur
paralyzed. !
Pulse-Temperature Dissociation (uncommon)
Rose Spots (Pathognomonic, present in 25% of cases)
Dla c
i ?i maculars?ots
mmovertru  i stitutedo t
ebasiso„asi lecidaltesturt
ermore,i areas
‰
   

 
  
 w
ere „ever due to i „ectious causes is a commo  occurre ce t
e



   
 ?ossibilityexistst
at„alse?ositivereactio smayoccurasaresulto„
The carrier stage varies from a number of days to years. o ty?
oid
Only about 3% of cases go on to become lifelong carriers of the Should infected people be isolated
germ and Because the germ is passed in the feces of infected people,
This tends to occur more often in adults than in children. o ly ?eo?le wit
 active diarr
ea who are unable to control their
bowel habits (infants, certain handicapped individuals) should be




r

 isolated.
Blood Culture Most infected people may return to work or school when they have
j
 !


recovered, provided that they carefully wash hands after toilet
0 visits.
Sub cultures are done after overnight incubation at 37 c,and
subcultures are done on Mac Conkey's agar Subcultures are  




  
repeated upto 10 days after futher incubation. Salmonella on Mac
Conkey's agar Salmonella on XLD agar A vaccine is availablebut is generally reserved for people traveling to


 underdeveloped countries where significant exposure may occur.
In 1896 Widal a professor of pathology and internal medicine at the Strict attention to food and water precautions while traveling to
University of Paris (1911ʹ29), he developed a procedure for such countries is the most effective preventive method.
diagnosing typhoid fever based on the fact that antibodies in the o accination
blood of an infected individual cause the bacteria to bind together o If you know you are going to an area that is ͞at-risk͟
into clumps (the Widal reaction). for this disease, get a vaccination.
cidaltest tilla?o?ulartest o The vaccination comes in the form of injections and
The Widal test (Widal͛s agglutination reaction) is routinely practised pills.
for the serodiagnosis of typhoid fever by most of the laboratories. o  


Several workers have expressed doubt regarding the reliability of o Two types of vaccines are available
the test. Several factors have contributed to this uncertainty. These o Oral and Inject able
include poorly standardised antigens, the sharing of antigenic
determinants with other Salmonellae and the effects of
immunisation with TAB vaccine. Another major problem relates to
the difficulty of interpreting Widal test results in areas where
Salmonella typhi is endemic and where the antibody titres of the
normal population are often not known.
o Oral ʹ A live oral vaccine ( typhoral ) is a stable
mutant of S.typhi strain Ty 21a lacking the enzyme
UDP Galactose -4-epimerase.
One capsule given orally taken before food, with glass of water or
milk, on 1, 3, 5 days ( three doses )
No antibiotics should be taken during the period of administration
Limitatio so„cidaltest of vaccine
Classically, a „our„old rise o„ a tibody i  ?aired sera cidal test is o   

co sidered dia ostic o„ ty?
oid „ever owever, ?aired sera are
o„te  di„„icult to obtai  a d s?eci„ic c
emot
era?y
as to be
 o The inject able vaccine, ( typhim ʹvi) contains purified o Choose foods processed for safety
i polysaccharide antigen derived from S.typhi strain o Prepare food carefully
ty21 o Foods prepared by others (avoid if possible)
o Given as single subcutaneous or intramuscular o ëeep food contact surfaces clean (3 wash cycle)
o Eat cooked food as soon as possible
injection
o Single dose is adequate. "#$%#"
o  

Worldwide, typhoid fever affects roughly 17 million people
annually, causing nearly 600,000 deaths. The causative agent,
Both vaccines are given to only > 5 years of age. almo ellae tericaty?
i (referred to asalmo ellaty?
ifrom now
on), is an obligate parasite that has no known natural reservoir
Immunity lasts for 3 years outside of humans. Little is known about the historical emergence
of human  ty?
i infections, however it is thought to have caused
Need a booster the deaths of many famous figures such as British author and poet
Rudyard ëipling, the inventor of the airplane, Wilbur Wright, and
If you know you are traveling to an at risk location: the Greek Empire͛s Alexander the Great. The earliest recorded
o 

!  epidemic occurred in Jamestown, A where it is thought that 6,000
people died of typhoid fever in the early 17th Century. This disease
 ?eci„ic a tibiotics are o„te  used to treat cases o„ is rare in the United States and developed nations, but always poses
ty?
oid. the risk of emergence.
o Antibiotic Resistance is increasing
o First-Line: Fluoroquinolones
o Alternative antibiotics (resistance is common)
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6 Chloramphenicol Originally isolated in 1880 by ëarl J. Erberth,ty?
i is a multi-organ
6 Amoxicillin pathogen that inhabits the lympathic tissues of the small intestine,
6 Trimethoprim-Sulfamethoxazole liver, spleen, and bloodstream of infected humans. It is not known
(Septra) to infect animals and is most common in developing countries with
poor sanitary systems and lack of antibiotics, putting travelers to
o 3

 

Asia, Latin America, and Africa in a high risk group. Of the 266
o With prompt antibiotic therapy, more than 99% of the people infected in the United States in 2002, approximately 70%
people with typhoid fever are cured, although had traveled internationally within 6 weeks of the onset of disease.
convalescence may last several months. The antibiotic
chloramphenicolSome Trade Names o Causative Agent: !

 
CHLOROMYCETIN $r![#"
is used worldwide, but increasing resistance to it has
prompted the use of other antibiotics (such as !




trimethoprim-sulfamethoxazole (more commonly known as the bacteria responsible for typhoid
BACTRIM fever)
SEPTRA can be very dangerous if not taken care of properly.
or ciprofloxacin
o [
 -only live in the bloodstream or intestinal tract of humans,
 -but is also found in sewage. Typhoid fever can cause a variety of symptoms to occur to the
Even though most people either die or use antibiotics to stop the person that has contracted Salmonella typhi. Some of the
growth of these bacteria, a very small percentage of the people who most common symptoms are severe
eadac
es, abdomi al
get typhoid fever have certain antibodies that are able to restrict ?ai s,„evers, and diarr
ea. Sometimes, rosecoloreds?ots can
the growth of salmonella typhi and therefore are able to live. appear on the abdomen and chest. One severe long-term
effect that can occur is that the bacteria can produce ulcers
These people plus the people that are cured through antibiotics are
called carriers because even though they will have no more
symptoms of typhoid fever, they will still have the bacteria inside of
them.
Since salmonella typhi is passed through bodily fluids, you can
contract it by eating some food or a drink handled by a carrier. You
can also contract these bacteria by having food or water that has
been contaminated with sewage containing salmonella typhi.
MICROBIOLOGICAL CHARACTERISTICS:
This gram-negative enteric bacillus belongs to the family
E terobacteriaceae.
It is a motile, facultative anaerobe that is susceptible to various
antibiotics.
Currently, 107 strains of this organism have been isolated, many
containing varying metabolic characteristics, levels of virulence, and
multi-drug resistance genes that complicate treatment in areas that
resistance is prevalent.
Diagnostic identification can be attained by growth on MacConkey
and EMB agars, and the bacteria is strictly non-lactose fermenting. It
also produces no gas when grown in TSI media, which is used to
differentiate it from other E terobacteriaceae.
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uma s in countries where the water is contaminated with sewage,
which can sometimes contain salmonella typhi.
cÿrr!‰#%"$
o t
ei testi alwalls. This can later lead to holes forming in
the intestine walls and the allowing of the contents of the
intestine to spill into the abdomen, causing severe abdominal
pain and infection.
!r#‰$!!(r
The symptoms of typhoid fever can begin to occur one to three
weeks after the person has contracted Salmonella typhi.
These symptoms then usually get the worst during the third
week of symptoms and then subside. By the fourth week,
many people do not have any of the symptoms of typhoid
fever.
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Typhoid fever affects about 400 people in the United States each
year. Of these 400 people, 70% of them got the Salmonella
typhi while traveling internationally. In developing nations
though, 12.5 million people are affected by this disease each
year.
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Today, there are many antibiotics that are available to restrict the
growth of Salmonella typhi. Some of these are ampicillin,
trimethoprim-sulfamethoxazole, and ciprofloxacin. The most
effective weapon against Salmonella typhi though is good
personal hygiene and public sanitation.
Usually found contracted in the develo?i  atio s of the world
such as the Latin American, African, and Asian countries. The
reason for this is that the water in these countries is
contaminated often with sewage that on some occasions is
carrying Salmonella typhi.

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