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Jump to: navigation, search For an unrelated disease with a similar name, see typhus. For a related disease which is caused by two different bacteria, see Paratyphoid fever. For the character in the 2005 film Elektra, see Typhoid (Elektra). Typhoid fever, also known as Salmonella Typhi or commonly just typhoid, is an illness. Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. Salmonella Typhi, more correctly called Salmonella enterica enterica Typhi, then alters its structure to resist destruction and allow them to exist within the macrophage. This renders them resistant to damage by PMN's, complement and the immune response. The organism is then spread via the lymphatics while inside the macrophages. This gives them access to the reticuloendothelial system and then to the different organs throughout the body. The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacterium grows best at 37 °C/99 °F – human body temperature.
Incidence of typhoid fever
♦ Strongly endemic ♦ Endemic ♦ Sporadic cases
Typhoid fever is characterized by a slowly progressive fever as high as 40 °C (104 °F), profuse sweating, gastroenteritis, and nonbloody diarrhea. Less commonly a rash of flat, rose-colored spots may appear. Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week. In the second week of the infection, the patient lies prostrated with high fever in plateau around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse
. Amoxicillin and ciprofloxacin. but sometimes agitated. Delirium is frequent. this can be very serious but is usually non-fatal. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Rose spots appear on the lower chest and abdomen in around 1/3 patients.  Diagnosis Diagnosis is made by any blood. the treatment of choice is a fluoroquinolone such as ciprofloxacin otherwise. Intestinal perforation in distal ileum: this is a very serious complication and is frequently fatal. chloramphenicol. after excluding malaria. Dehydration ensues and the patient is delirious (typhoid state). have been commonly used to treat typhoid fever in developed countries. comparable to pea-soup. Typhoid fever in most cases is not fatal. green with a characteristic smell. trimethoprim-sulfamethoxazole. Antibiotics.  Treatment Where resistance is uncommon. cholecystitis.wave. dysentery or pneumonia. bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). By the end of third week the fever has started reducing (defervescence). constipation is also frequent. However. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. This delirium gives to typhoid the nickname of "nervous fever". a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice. endocarditis and osteitis The fever is still very high and oscillates very little over 24 hours. Diarrhea can occur in this stage: six to eight stools in a day. The spleen and liver are enlarged (hepatosplenomegaly) and tender and there is elevation of liver transaminases. Cefixime is a suitable oral alternative. Encephalitis Metastatic abscesses. Blood cultures are sometimes still positive at this stage. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in. The Widal reaction is strongly positive with antiO and antiH antibodies. a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures. frequently calm. such as ampicillin. There are rhonchi in lung bases. In epidemics and less wealthy countries. The term "enteric fever" is a collective term that refers to typhoid and paratyphoid. This carries on into the fourth and final week.) In the third week of typhoid fever a number of complications can occur: Intestinal hemorrhage due to bleeding in congested Peyer's patches. (The major symptom of this fever is the fever usually rises in the afternoon up to the first and second week.
chloramphenicol. Death occurs in between 10% and 30% of untreated cases.0 mg/l) would not be picked up by this method. It is not certain how this problem can be solved. Pakistan. and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin". trimethoprim-sulfamethoxazole and streptomycin is now common. It has also been suggested Azithromycin is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. the recommended first line treatment is ceftriaxone.  Resistance Resistance to ampicillin. Though in some communities case-fatality rates may be as high as 47%. Texas Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. and these agents have not been used as first line treatment now for almost 20 years. an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in South America. Thailand or Vietnam. Typhoid does not affect animals and therefore transmission is only from human to human. Ciprofloxacin resistance is an increasing problem. especially in the Indian subcontinent and Southeast Asia. There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL).125–1. Azithromycin significantly reduces relapse rates compared with ceftriaxone. typhoid fever persists for three weeks to a month. For these patients. oral Ty21a vaccine (sold as Vivotif Berna) and the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline). Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).When untreated. India. Prevention Doctor administering a typhoid vaccination at a school in San Augustine County. There are two vaccines currently recommended by the World Health Organization for the prevention of typhoid: these are the live. Careful food preparation and washing of hands are therefore crucial to preventing typhoid. Bangladesh. because most laboratories around the world (including the West) are dependent on disc testing and cannot test for MICs. Both are between 50 to 80% protective and are recommended for travelers to .
the World Health Organization identifies typhoid as a serious public health problem.S.000 deaths in endemic areas. 1906–1960 Many carriers of typhoid were locked into an isolation ward never to be released in order to prevent further typhoid cases. because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection). the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U. These people often deteriorated mentally. There exists an older killed whole-cell vaccine that is still used in countries where the newer preparations are not available. The most famous asymptomatic carrier was Mary Mallon (commonly known as "Typhoid Mary"). driven mad by the conditions they lived in. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. Death rates for typhoid fever in the U. A person may become an asymptomatic carrier of typhoid fever. Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic". 1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a water well (center)  Transmission Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions.areas where typhoid is endemic. but capable of infecting others.000 to 600. three of whom died from the disease. . but this vaccine is no longer recommended for use. suffering no symptoms.  Epidemiology With an estimated 16–33 million cases of annually resulting in 500. a young cook who was responsible for infecting at least 53 people with typhoid. According to the Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover. Its incidence is highest in children and young adults between 5 and 19 years old.S. According to statistics from the United States Center for Disease Control.
ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Mary quit her job but returned later under a false name.S. including their leader Pericles. typhoid fever mortality rate in Chicago averaged 65 per 100. In 1909. when the typhoid death rate was 174 per 100. The most notorious carrier of typhoid fever—but by no means the most destructive—was Mary Mallon. but he survived to write about the plague. slow fever. Frederick F. some believe she was the source of infection for several hundred people. with modern academics and medical scientists considering epidemic typhus the most likely cause. nervous fever. She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until her death in 1938. The balance of power shifted from Athens to Sparta. She is closely associated with forty-seven cases and three deaths. The worst year was 1891. as a derivative from typhus. She was detained and quarantined after another typhoid outbreak. Army physician. Other scientists have disputed the findings. killed one third of the population of Athens. a U. citing serious methodologic flaws in the dental pulpderived DNA study.000 people a year. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Ancient historian Thucydides also contracted the disease. The CFTR protein is present in both the lungs and the intestinal epithelium. In 1907. pythogenic fever. etc. The cause of the plague has long been disputed. a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever. Mary Mallon ("Typhoid Mary") in a hospital bed. abdominal typhus. The name of " typhoid " was given by Louis in 1829. developed an American typhoid vaccine and two years later his . such as gastric fever. the bends. during the period in question. In 1897. she became the first American carrier to be identified and traced. the whole population of Attica was besieged within the Long Walls and lived in tents. She died of pneumonia after 26 years in quarantine. also known as Typhoid Mary.000 people. She was a cook in New York. In the late 19th century. which some believe to have been typhoid fever. and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium. The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions.C. Heterozygous advantage It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. This fever received various names. a devastating plague. Almroth Edward Wright developed an effective vaccine. His writings are the primary source on this outbreak. infantile remittent fever.  History Around 430–424 B. Russell.. However.
Antibiotics were introduced in clinical practice in 1942.000 cases and 214 deaths. It eliminated typhoid as a significant cause of morbidity and mortality in the U. Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene.vaccination program became the first in which an entire army was immunized. .S. greatly reducing mortality. Typhoid fever was also known as suette milliaire in nineteenth-century France. military.000 people per year. Today. An outbreak in the Democratic Republic of Congo in 2004–05 recorded more than 42. incidence of typhoid fever in developed countries is around 5 cases per 1.000.
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