| Typhoid fever is a serious, contagious bacterial infection caused by Salmonella typhi or Salmonella paratyphi. The organism enters through the gastrointestinal tract and spreads through the circulatory system (bacteremia), inflaming the lining (intestinal mucosa) of the small and large intestines. Severe cases can lead to delirium or coma, and may be life-threatening.
Typhoid bacteria are shed in the feces and urine of infected individuals. Inadequate hand washing after defecation or urination can contaminate food and water supplies. Rarely, domestic animals may serve as a reservoir for paratyphoid. Flies may spread the disease from feces to food, causing epidemics in areas with poor sanitation practices. Hospital workers who do not follow the hospital's sterile procedures can be infected through the soiled linens of infected individuals.
Although some infected individuals do not develop actual symptoms, they are still capable of spreading the disease to others (carriers). In the US, many of the estimated 2,000 carriers are elderly women with chronic gallbladder disease.Incidence and Prevalence: Now rare in the US, typhoid fever is still common in areas with poor sanitation such as underdeveloped areas of Africa, Asia, and Latin America. Worldwide, in the year 2000 there were 21.6 million cases of typhoid fever and 5.4 million cases of paratyphoid fever (Crump 346). |
Source: Medical Disability Advisor
| History: The individual may report symptoms such as chills, high fever, headache, cough, sore throat, a generalized feeling of illness (malaise), abdominal pain, urinary tract symptoms, and constipation. Constipation may later turn into "pea soup" diarrhea. Fever plateaus after 7 to 10 days, leaving the individual exhausted. Physical exam: The exam will typically reveal an inflamed throat and nasal mucosa. A fever will be present. In certain individuals the pulse may be slow (bradycardia). Palpation may reveal an enlarged spleen (splenomegaly). In 10% of the cases, a rash (rose spots) will be found on the trunk during the second week of the disease. The fever remains high for 7 to 10 days and will usually decline to normal during the fourth week. In severe cases, delirium or confusion may be noted. The infection may also cause pneumonia-like symptoms or symptoms similar to a urinary tract infection. Tests: Blood, feces, and urine may be cultured for the presence of the Salmonella bacteria. This may be augmented by a direct agglutination test (Widal test) performed in the serology laboratory to detect the presence of specific anti-Salmonella antibodies manufactured by the body against S. typhi. A febrile agglutination test is also used to help diagnose typhoid by measuring antibody response to specific antigens. Blood samples may indicate a low platelet count and a low white blood cell count. |
Source: Medical Disability Advisor
| Bacterial infection can usually be treated effectively with antibiotics. Treatment of typhoid fever can be complicated, however, by the presence of antibiotic-resistant bacteria. Because the bacteria are often harbored in the biliary tree, gallbladder surgery may be used if antibiotic treatment is ineffective. Chronic carriers, if identified, are treated with an extended course of antibiotic therapy to eliminate the typhoid bacteria.
To prevent dehydration and electrolyte imbalance, fluids and electrolytes lost in diarrhea must be replaced. Antidiarrheal medicines and narcotics may be used to prevent cramping and the continued loss of fluids.
In severe cases, corticosteroid drugs may be necessary to treat central nervous system symptoms such as seizures, shock, or delirium that have occurred as the result of high fever.
Perforation of the intestine will require emergency surgery. High doses of intravenous antibiotics may be used to correct systemic infection that results from perforation and the release of intestinal contents into the abdominal cavity.
Vaccines are now available for use in preventing typhoid fever in countries with widespread exposure and for travelers to high-risk areas or individuals exposed to drug-resistant S. typhi or S. paratyphi. |
Source: Medical Disability Advisor
| With prompt and appropriate treatment, most individuals recover in 2 to 4 weeks. Complications can occur in those who are not treated or in whom treatment is delayed. Untreated and severe typhoid can result in coma or death. Relapses can occur in up to 15% of affected individuals, even with treatment. |
Source: Medical Disability Advisor
| Complications may include dehydration, intestinal perforation, hemorrhage, peritonitis, anemia, pneumonia, or inflammation of the liver or spleen. Bacteria in the bloodstream (bacteremia) can result in infection in the bones (osteomyelitis), joints (arthritis), kidneys (glomerulitis), heart valves (endocarditis), lining of the brain (meningitis), and genitals or the urinary tract. Muscle infection can result in abscesses. The infection could also affect the gallbladder and central nervous system. |
Source: Medical Disability Advisor
| Food handlers should be considered unfit for handling food until proven to be bacteria free. Individuals who suffer intestinal perforation should be given less strenuous work assignments during recovery from the surgery. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have chills, high fever, headache, cough, sore throat, generalized feeling of illness (malaise), abdominal pain, and constipation? Did the constipation later turn into diarrhea?
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Was the diagnosis of typhoid fever confirmed by the presence of Salmonella typhi antibodies and antigens in the blood?
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Have other conditions with similar symptoms, such as tuberculosis, infective endocarditis, brucellosis, lymphoma, Q fever, viral hepatitis, malaria, and amebiasis, been ruled out?
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Is there evidence of systemic infection or organ system involvement?
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Would individual benefit from consultation with an infectious disease specialist?
Regarding treatment:
- Was individual treated promptly with the appropriate antibiotic therapy?
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Did the symptoms persist despite treatment? Were culture and sensitivity tests done to determine the possibility of antibiotic resistance? Has the antibiotic therapy been adjusted appropriately?
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Is individual a chronic carrier? If so, was the course of antibiotic therapy extended appropriately?
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Was there evidence of biliary involvement? Was surgery indicated?
Regarding prognosis:
- Did adequate time elapse for recovery (2 to 4 weeks)?
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Does individual have an underlying immune suppressive condition that may warrant lifelong suppressive therapy?
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Has individual suffered any associated complications (i.e., intestinal perforation, peritonitis, hemorrhage, organ system involvement) that could impact recovery and prognosis? Have the complications been addressed in the treatment plan?
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If individual is a carrier, has instruction been given regarding prevention of disease transmission?
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Source: Medical Disability Advisor
| Crump, John A., Stephen P. Luby, and Eric D. Mintz. "The Global Burden of Typhoid Fever." Bulletin of the World Health Organization (BLT) 82 5 (2004): 346-353. World Health Organization. World Health Organization. 13 Jan. 2005 <http://www.who.int/bulletin/volumes/82/5/en/346.pdf>. |
Source: Medical Disability Advisor
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