Typhoid fever

Answer 1

Definition

Typhoid fever is a bacterial infection characterized by diarrhea, systemic disease, and a rash -- most commonly caused by the bacteria Salmonella typhi (S. typhi).

Alternative Names

Enteric fever

Causes, incidence, and risk factors

The bacteria that causes typhoid fever -- S. typhi -- spreads through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enters your body, and goes into your intestines, and then into your bloodstream, where it can travel to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.

A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.

Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from overseas.

Symptoms

Early symptoms include fever, general ill-feeling, and abdominal pain. A high (over 103 degrees) fever and severe diarrhea occur as the disease gets worse.

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the belly and chest.

Other symptoms that occur include:

• Abdominal tenderness
• Agitation
• Bloody stools
• Chills
• Confusion
• Difficulty paying attention (attention deficit)
• Delirium
• Fluctuating mood
• Hallucinations
• Nosebleeds
• Severe fatigue
• Slow, sluggish, lethargic feeling
• Weakness

Signs and tests

A complete blood count (CBC) will show a high number of white blood cells.

A blood cultureduring first week of the fever can show S. typhibacteria

Other tests that can help diagnose this condition include:

• Stool culture
• ELISA urine test to look for the bacteria that causes Typhoid fever
• Platelet count(platelet count will be low)
• Fluorescent antibody study to look for substances specific to Typhoid bacteria

Treatment

Fluids and electrolytes may be given through a vein (intravenously). Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.

Expectations (prognosis)

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.

Symptoms may return if the treatment has not completely cured the infection.

Complications

• Intestinal hemorrhage (severe GI bleeding)
• Intestinal perforation
• Kidney failure
• Peritonitis

Calling your health care provider

Call your health care provider if you have had any known exposure to typhoid fever or if you have been in an endemic area and symptoms of typhoid fever develop. Also call your health care provider if you have had typhoid fever and relapse occurs or if severe abdominal pain, decreased urine output, or other new symptoms develop.

Prevention

Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks.

Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well cooked food. Experimentation with an oral live attenuated typhoid vaccine is now underway and appears promising.

Adequate water treatment, waste disposal, and protection of food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

References

Bhutta ZA. Typhoid fever. In: Rakel P, Bope ET, eds. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 48.

Kaye KS, Kaye D. Salmonella infections (including typhoid fever). In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 329.

Answer 2

Definition

Typhoid fever is an infection that causes diarrhea and a rash -- most commonly due to a type of bacteria called Salmonella typhi (S. typhi).

Alternative Names

Enteric fever

Causes, incidence, and risk factors

The bacteria that cause typhoid fever -- S. typhi -- spread through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enter your body. They travel into your intestines, and then into your bloodstream, where they can get to your lymph nodes, gallbladder, liver, spleen, and other parts of your body.

A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.

Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

Symptoms

Early symptoms include fever, general ill-feeling, and abdominal pain. A high (typically over 103 degrees Fahrenheit) fever and severe diarrhea occur as the disease gets worse.

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Other symptoms that occur include:

• Abdominal tenderness
• Agitation
• Bloody stools
• Chills
• Confusion
• Difficulty paying attention (attention deficit)
• Delirium
• Fluctuating mood
• Hallucinations
• Nosebleeds
• Severe fatigue
• Slow, sluggish, lethargic feeling
• Weakness

Signs and tests

A complete blood count (CBC) will show a high number of white blood cells.

A blood cultureduring the first week of the fever can show S. typhibacteria.

Other tests that can help diagnose this condition include:

• ELISA urine test to look for the bacteria that cause Typhoid fever
• Fluorescent antibody study to look for substances that are specific to Typhoid bacteria
• Platelet count(platelet count will be low)
• Stool culture

Treatment

Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets.

Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.

Expectations (prognosis)

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.

Symptoms may return if the treatment has not completely cured the infection.

Complications

• Intestinal hemorrhage (severe GI bleeding)
• Intestinal perforation
• Kidney failure
• Peritonitis

Calling your health care provider

Call your health care provider if:

• You have had any known exposure to typhoid fever
• You have been in an endemic area and you develop symptoms of typhoid fever
• You have had typhoid fever and the symptoms return
• You develop severe abdominal pain, decreased urine output, or other new symptoms

Prevention

Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. If you are traveling to an area where there is typhoid fever, ask your health care provider if you should bring electrolyte packets in case you get sick.

Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well-cooked food. Studies of an oral live attenuated typhoid vaccine are now under way and appear promising.

Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

References

Giannella Ra. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107.

Lima AAM, Guerrant RL. Inflammatory enteritides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchill Livingstone; 2009:chap 97.

Reviewed By

Review Date: 06/09/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.