Typhoid fever

Typhoid fever

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ICD-10	A01.0
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ICD-9	002
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Typhoid fever (or enteric fever) is an illness caused by the bacterium Salmonella Typhi. Common worldwide, typhoid fever is transmitted by ingestion of food or water contaminated with feces from an infected person. Once ingested, the bacteria multiply in the blood stream of the infected person, are absorbed into the digestive tract, and eliminated with the waste.

Symptoms

After infection, symptoms include:

• incubation period is 10 to 20 days
• a high fever from 39 °C to 40 °C (103 °F to 104 °F) that rises slowly
• chills
• Bouts of sweating
• bradycardia (slow heart rate)
• Cough
• skin symptoms
• children often vomit and have diarrhea
• weak and rapid pulse
• weakness
• diarrhea
• headaches
• myalgia (muscle pain)- not to be confused with the more severe muscle pain in Dengue fever, known as "Breakbone fever"
• lack of appetite
• constipation
• stomach pains
• in some cases, a rash of flat, rose-colored spots called "rose spots"
• in some cases, loss of hair resulting from the prolonged high fever
• extreme symptoms such as intestinal perforation or hemorrhage, delusions and confusion are also possible

Diagnosis

Diagnosis of typhoid fever is made by blood culture, bone marrow or stool cultures, and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentery and pneumonia, a therapeutic trial with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.

Treatment

Typhoid fever can be fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. Usage of Ofloxacin along with Lactobacillus acidophilus is also recommended.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa and Latin America). Typhim Vi, which is an intramuscular killed- bacteria vaccination, and Vivotif, a live, oral bacteria vaccination, both protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither protects against unrelated typhus.

Resistance

Resistance to antibiotics like ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid fever that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centers are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone.

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), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (Mean inhibitory concentration (MIC) 0.125–1.0 mg/l) would not be picked up by this method. It not certain how this problem can be solved since most laboratories around the world (including the West) are dependent on disc testing and cannot test for MICs.

Transmission

While flying insects feeding on feces may occasionally transfer the bacteria to food being prepared for consumption, typhoid fever is most commonly transmitted through poor hygiene habits and poor public sanitation conditions. Public education campaigns encouraging people to wash their hands after using the lavatory and before handling food are an important component in controlling spread of this disease.

A person may become an asymptomatic (suffering no symptoms)carrier of typhoid fever, but capable of infecting others. According to the Centers for Disease Control, approximately 5% of people who contract typhoid continue to carry the disease even after they recover.

The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mar]. In 1907, she became the first American carrier to be identified and traced. She was a cook in New York at the beginning of the 20th Century. Some believe she was the source of infection for several hundred people. She is closely associated with fifty cases and five deaths. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job, but returned later under a false name. After another typhoid outbreak, she was detained and quarantined. She died of a stroke after 26 years in quarantine.

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. The CFTR protein is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.

History

• 430- 426 B.C.E.: a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. The balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides also contracted the disease, but survived to write about the plague. His writings are the primary source on this outbreak. The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a study in 2006 by Manolis Papagrigorakis of the University of Athens detected DNA sequences similar to those of the bacterium responsible for typhoid fever. Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. In addition, as the disease is most commonly transmitted through poor hygiene habits and poor public sanitation conditions, it is an unlikely cause of a widespread plague, emerging in Africa and moving into the Greek city states, as reported by Thucydides.

• 1860-1900: Chicago typhoid fever mortality rate averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 persons.[1]

• 1897: Edward Almwroth Wright develops the effective vaccine

Famous typhoid fever victims

Other famous people who have succumbed to the disease include:

• Alexander the Great
• Pericles
• Archduke Karl Ludwig of Austria
• William the Conqueror
• Franz Schubert
• Margaret Breckenridge (highest-ranking Army nurse under Ulysses S. Grant)
• Evangelista Torricelli
• Caroline Harrison (Benjamin Harrison's wife)
• Annie Lee (Robert E. Lee's daughter)
• Mary Henrietta Kingsley
• Herbert Hoover's father and mother
• Mark Hanna
• Katherine McKinley (William McKinley's daughter)
• Wilbur Wright
• Will Rogers' mother
• Leland Stanford, Jr.
• William T. Sherman's father
• Albert of Saxe-Coburg-Gotha (British prince consort and Queen Victoria's husband)
• Ann Rutledge (alleged fiancée of Abraham Lincoln)
• William Wallace Lincoln (third son of President Abraham Lincoln and Mary Todd Lincoln)
• Tad Lincoln (fourth and youngest son of President Abraham Lincoln and Mary Todd Lincoln)
• Stephen A. Douglas
• Cecile and Jeanne Pasteur (Louis Pasteur's daughters)
• Abigail Adams (President John Adams's wife)
• K.B. Hedgewar (founder of Rashtriya Swayamsewak Sangh)
• General Stonewall Jackson's mother, father, and daughter
• John Buford
• Annie Darwin (Charles Darwin's daughter)
• Joseph Lucas
• Ignacio Zaragoza

References

ISBN links support NWE through referral fees

• Gale's Encyclopedia of Medicine. Thomas Gale: 1999. ISBN 0-7876-1868-3

External links

• Centers for Disease Control and Prevention
• www.netdoctor.co.uk. Article on typhoid fever for travelers. Retrieved 17 February, 2006.
• Harrison, Noel G. (2004). www.healthsystem.virginia.edu. Historical exhibit on efforts by US Army to control typhoid fever. Retrieved 4 July, 2006.jahangeer
• www.medicalnewstoday.com. Article on typhoid fever and the fall of Athens. Retrieved 17 February, 2006.
• Pathology of Typhoid Fever

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