TYPHOID

Typhoid, or enteric, fever is a serious systemic disease caused by a bacillus, Salmonella typhi. Paratyphoid fever is closely related, though generally less severe. The enteric fevers have an incubation period of one to four weeks, followed by a slow onset and prolonged course, primarily affecting the gastrointestinal tract. There is a low fever and severe toxemia. A skin rash may occur in the early stages, and later other organs (liver, kidneys, bone marrow, brain) may be invaded. Typhoid is fatal in about 3 to 4 percent of cases, with higher proportions occurring where diagnostic and treatment facilities are inadequate. Diagnosis sometimes can be made clinically on the basis of patient history and physical examination, but usually depends on isolating the organism from feces or blood culture. Worldwide there are about 16 million cases annually, resulting in 600,000 deaths; in the United States there are usually less than 500 cases a year.

Typhoid is transmitted in feces—usually in polluted water, though sometimes in food that has been prepared under unhygienic conditions by a convalescent or chronic carrier. Humans are the only host for typhoid bacilli, but paratyphoid can be carried and transmitted by domestic animals. Cases continue to excrete the infective organisms in feces, and sometimes in urine, for varying periods, sometimes up to several months after apparent clinical recovery. A chronic (e.g., virtually permanent) carrier state occurs in a small number of cases; "Typhoid Mary" was a notorious example.

There may be other intermediaries between the human source and the victim who consumes contaminated water or food. For instance, water in a river estuary polluted with raw sewage containing typhoid bacilli may be ingested by shellfish or mussels, and these are then infective. It does not require a massive dose of viable typhoid bacilli to cause the disease. There are many well-documented cases of typhoid following ingestion of minuscule amounts of contaminated water or food. For instance, it suffices to eat a few lettuce leaves from a salad that was washed in contaminated water. For this reason, travelers to regions where typhoid is endemic must exercise extreme caution in what they eat and drink. All those who travel to places where typhoid occurs should also be offered prophylactic typhoid vaccine. In the past this has required several injections of vaccine, which often induced painful and sometimes unpleasantly toxic reactions. An oral vaccine is now available.

Cases of typhoid are treated with antibiotics, and notification to public health authorities is mandatory. It is rare in communities with efficient sanitary sewage disposal services and pure water supplies—the occurrence of even a single case indicates a breakdown of sanitation and hygiene in such communities, unless the disease was acquired elsewhere. A careful and complete epidemiological investigation of every case, including a detailed history of food and fluid intake, is therefore essential in order to identify the source of the infection so it can be controlled. Epidemics of typhoid rarely occur now, although they are always a potential threat when disasters such as earthquakes and floods disable sewage treatment plants. Until about the first quarter of the twentieth century, typhoid fever was endemic in all nations, and it caused the deaths of many famous people, including Albert, the consort of Queen Victoria;U.S. president Zachary Taylor; and English poet Rupert Brooke.

John M. Last

(see also: Food-Borne Diseases; Typhoid Mary; Waterborne Diseases )

typhoid fever acute, generalized infection caused by Salmonella typhi. The main sources of infection are contaminated water or milk and, especially in urban communities, food handlers who are carriers. The symptoms of typhoid appear 10 to 14 days after infection; they include high fever, rose-colored spots on the abdomen and chest, diarrhea or constipation, and enlargement of the spleen. Complications, especially in untreated patients, may be numerous, affecting practically every body system, and they account for the mortality rate of 7% to 14%. Perforation of the intestine with hemorrhage is not uncommon. Chloramphenicol is the most effective drug in combating typhoid, and in very toxic patients a cortisone derivative may be helpful. Skilled nursing care is still of the utmost importance, as is a high caloric diet to prevent wasting of the body. Vaccination against typhoid is a valuable preventive measure, especially for persons in military service and for those who live in or travel to poorly sanitized regions.

typhoid fever (ty-foid) n. an infection of the digestive system by the bacterium Salmonella typhi, causing general weakness, high fever, a rash of red spots on the chest and abdomen, chills, sweating, and in serious cases inflammation of the spleen and bones, delirium, and erosion of the intestinal wall leading to haemorrhage. It is transmitted through contaminated food or drinking water. Treatment with such antibiotics as ciprofloxacin or chloramphenicol reduces the severity of symptoms. The TAB vaccine provides temporary immunity. Compare paratyphoid fever.

Typhoid Fever

What Is Typhoid?

What Causes Typhoid Fever?

What Happens When People Have Typhoid Fever?

How Is Typhoid Fever Prevented?

Resources

Typhoid fever is a bacterial infection that is common in many parts of the world. It is spread by contaminated water and food and primarily affects the digestive system.

KEYWORDS

for searching the Internet and other reference sources

Foodborne diseases

Salmonella typhi

Waterborne diseases

What Is Typhoid?

In many developing countries, typhoid fever is a major problem. It is estimated to cause 16 million illnesses and more than half a million deaths each year worldwide. It is especially common in parts of Asia, Africa, and South America where pure water is not readily available and sewage treatment is limited. In many countries, children are the most likely to get typhoid.

The U.S. and the World

About 16 million cases of typhoid fever occur each year worldwide, and more than 600,000 people die from it.

The disease is common in many underdeveloped nations of the world, especially parts of Asia and in South America with unsanitary water and food preparation. The situation is made more difficult because the disease is showing resistance to some of the traditional antibiotics used to treat those who are infected.

About 400 cases a year are reported in the United States, but about 70 percent of them involve people who had traveled overseas.

In 1998-1999,13 people in Florida contracted typhoid fever when they drank shakes made with a frozen tropical fruit containing Salmonelli typhi.

Typhoid fever is suspected in the deaths of such famous people as Alexander the Great, Wilbur Wright of the Wright Brothers, and poet Gerard Manley Hopkins.

Typhoid used to be a serious problem in the United States as well. Early in the twentieth century, before clean water supplies and sewage systems to dispose of human waste were widely available, it caused about 35,000 illnesses each year. Technological advancements in sewage and water treatment have made typhoid fever rare in industrialized countries. Only about 400 cases are reported each year in the United States. Most of them are acquired while traveling abroad.

What Causes Typhoid Fever?

Typhoid fever is caused by a bacterium called Salmonella typhi. It is related to the salmonella bacteria that cause food poisoning, but they are not exactly the same.

Salmonella typhi bacteria are present in the solid wastes (stool) of infected people, including some “healthy carriers” who have no symptoms of illness. The bacteria can spread if human waste gets into water that is used for drinking, irrigating crops, or washing food. Typhoid also occasionally is transmitted through an infected person who is working in food preparation. Once swallowed, the bacteria move from the digestive tract into the bloodstream and then to the liver, spleen, gall bladder, and lymph nodes.

Typhoid Mary

Some people, called carriers, can be infected with Salmonella typhi but not develop typhoid fever. If they prepare food for others, however, they may contaminate the food they handle and pass the bacteria on to other people who eat it and then may get sick.

The most famous typhoid carrier was Mary Mallon, also known as Typhoid Mary, who worked as a cook in homes in New York and New Jersey in the early 1900s. Fifty-one cases of typhoid fever resulting in three deaths were traced to her. Mallon never was sick herself, however, and she never accepted that she had infected anyone else.

Against her will, the authorities confined Mallon to a hospital on North Brother Island in New York’s East River. Three years later, in 1910, they released her on condition that she never work as a cook again. But in 1915, typhoid struck a maternity hospital in Manhattan, and it turned out that Mallon had cooked there. She spent the rest of her life, 23 years, as a captive on North Brother Island.

What Happens When People Have Typhoid Fever?

Symptoms

The symptoms of typhoid fever come on gradually. At first, people may get a headache, stomachache, and constipation*. They develop a fever and lose their appetite. In some cases, they may get rose spots, a rash mostly on the chest and abdomen. As symptoms worsen, the fever may rise as high as 103 to 104 degrees Fahrenheit. People often develop bloody diarrhea, become dehydrated (lose fluids faster than they are replaced), and start acting confused or disoriented. In severe cases, people may go into a coma, a state of deep unconsciousness, and die.

* constipation

is the sluggish movement of the bowels, usually resulting in infrequent hard stools.

Diagnosis and Treatment

A blood or urine test usually can detect the presence of the bacterium that causes typhoid fever. Antibiotic drugs that fight the bacterial infection can make the illness shorter and milder and prevent complications. Fluids may be given as well to counter the effects of diarrhea. Severe infections can lead to a perforation (hole) in the intestine that requires surgery to repair.

How Is Typhoid Fever Prevented?

Clean water supplies and effective waste disposal systems are the best ways of preventing typhoid, but these are lacking in many countries. A vaccine is available that is about 70 percent effective for several years.

Travelers to countries where typhoid fever is common should drink only boiled or bottled water. They should eat only food that has been properly cooked or fruit that they peel themselves and that has not been washed with tap water. The U.S. Centers for Disease Control and Prevention sums up advice for travelers this way: “Boil it, cook it, peel it, or forget it.”

See also

Bacterial Infections

Fever

Gastroenteritis

Salmonellosis

Resources

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road N.E., Atlanta, GA 30333. CDC posts a fact sheet about typhoid fever at its website. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm

World Health Organization (WHO), Avenue Appia 20, 1211 Geneva 27, Switzerland. WHO’s website posts fact sheets about typhoid fever and other vaccine preventable diseases at its website. http://www.who.org/home/map_ht.html

typhoid fever Acute, sometimes epidemic communicable disease of the digestive system. Caused by Salmonella typhi, which is transmitted in contaminated water or food, it is characterized by bleeding from the bowel and enlargement of the spleen. Symptoms include fever, headache, constipation, sore throat, cough, and skin rash.

ty·phoid / ˈtīˌfoid/ (also typhoid fever) • n. an infectious fever with an eruption of red spots on the chest and abdomen and severe intestinal irritation, caused by the bacterium Salmonella typhi. DERIVATIVES: ty·phoi·dal / tīˈfoidl/ adj.

typhoid ˈtīˌfoid also typhoid fever n.an infectious bacterial fever with an eruption of red spots on the chest and abdomen and severe intestinal irritation.
typhoidal adj.

typhoid •avoid, Boyd, Coed, droid, Floyd, Freud, Lloyd, overjoyed, self-employed, unalloyed, underemployed, unemployed, void •geoid • amoeboid (US ameboid) •globoid • cuboid • gadoid • typhoid •fungoid • discoid • tabloid • colloid •celluloid • mongoloid • alkaloid •coralloid • crystalloid • prismoid •arachnoid • sphenoid • hominoid •crinoid, echinoid •solenoid • humanoid • paranoid •hypoid • anthropoid • gabbroid •android • steroid • thyroid • hydroid •spheroid • meteoroid • Murgatroyd •Polaroid •haemorrhoid (US hemorrhoid) •asteroid • schizoid • factoid • mastoid •deltoid • planetoid • ovoid • trapezoid •rhizoid