Typhoid

Typhoid is a bacterial infection that can lead to a high fever, diarrhea, and vomiting. It can be fatal. It is caused by the bacteria Salmonella typhi.

The infection is often passed on through contaminated food and drinking water, and it is more prevalent in places where handwashing is less frequent. It can also be passed on by carriers who do not know they carry the bacteria.

Annually, there are around 5,700 cases in the United States, and 75 percent of these start while traveling internationally. Globally, around 21.5 million people a year contract typhoid.

If typhoid is caught early, it can be successfully treated with antibiotics; if it is not treated, typhoid can be fatal.

Fast facts on typhoid

Here are some key points about typhoid. More detail is in the main article.

  • Typhoid is a common bacterial infection in countries with low incomes.
  • Untreated, it is fatal in around 25 percent of cases.
  • Symptoms include a high fever and gastrointestinal problems.
  • Some people carry the bacteria without developing symptoms
  • Most cases reported in the United States are contracted overseas
  • The only treatment for typhoid is antibiotics

Typhoid is an infection caused by the bacterium Salmonella typhimurium (S. typhi).

 The bacterium lives in the intestines and bloodstream of humans. It spreads between individuals by direct contact with the feces of an infected person.

 No animals carry this disease, so transmission is always human to human.

 If untreated, around 1 in 5 cases of typhoid can be fatal. With treatment, fewer than 4 in 100 cases are fatal.

 S. typhi enters through the mouth and spends 1 to 3 weeks in the intestine. After this, it makes its way through the intestinal wall and into the bloodstream.

 From the bloodstream, it spreads into other tissues and organs. The immune system of the host can do little to fight back because S. typhi can live within the host's cells, safe from the immune system.

 Typhoid is diagnosed by detecting the presence of S. typhi via blood, stool, urine, or bone marrow sample.

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Typhoid is caused by the bacteria S. typhi and spread through food, drinks, and drinking water that are contaminated with infected fecal matter. Washing fruit and vegetables can spread it, if contaminated water is used.

Some people are asymptomatic carriers of typhoid, meaning that they harbor the bacteria but suffer no ill effects. Others continue to harbor the bacteria after their symptoms have gone. Sometimes, the disease can appear again.

People who test positive as carriers may not be allowed to work with children or older people until medical tests show that they are clear.

The 2 most common complications in untreated typhoid fever are:

  • internal bleeding in the digestive system
  • splitting (perforation) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

Internal bleeding

Most internal bleeding that occurs in typhoid fever isn't life threatening, but it can make you feel very unwell.

Symptoms include:

  • feeling tired all the time
  • breathlessness
  • pale skin
  • an irregular heartbeat
  • vomiting blood
  • poo (stools) that are very dark or tar-like

A blood transfusion may be required to replace lost blood, and surgery can be used to repair the site of the bleeding.

Perforation

Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.

Peritonitis is a medical emergency as the tissue of the peritoneum is usually sterile (germ-free).

Unlike other parts of the body, such as the skin, the peritoneum doesn't have an inbuilt defence mechanism for fighting infection.

In peritonitis, the infection can rapidly spread into the blood (sepsis) before spreading to other organs.

This carries the risk of multiple organ failure. If it isn't treated properly, it may result in death.

The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.

If you have peritonitis, you'll be admitted to hospital, where you'll be treated with antibiotic injections.

Surgery will then be used to seal the hole in your intestinal wall.

Symptoms normally begin between 6 and 30 days after exposure to the bacteria.

The two major symptoms of typhoid are fever and rash. Typhoid fever is particularly high, gradually increasing over several days up to 104 degrees Fahrenheit, or 39 to 40 degrees Celsius.

The rash, which does not affect every patient, consists of rose-colored spots, particularly on the neck and abdomen.

Other symptoms can include:

  • weakness
  • abdominal pain
  • constipation
  • headaches

Rarely, symptoms might include confusion, diarrhea, and vomiting, but this is not normally severe.

In serious, untreated cases, the bowel can become perforated. This can lead to peritonitis, an infection of the tissue that lines the inside of the abdomen, which has been reported as fatal in between 5 and 62 percent of cases.

Another infection, paratyphoid, is caused by Salmonella enterica. It has similar symptoms to typhoid, but it is less likely to be fatal.

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples. If a test result isn't clear, blood or urine samples will be taken to make a diagnosis.

The only effective treatment for typhoid is antibiotics. The most commonly used are ciprofloxacin (for non-pregnant adults) and ceftriaxone.

Other than antibiotics, it is important to rehydrate by drinking adequate water.

In more severe cases, where the bowel has become perforated, surgery may be required.

Typhoid antibiotic resistance

As with a number of other bacterial diseases, there is currently concern about the growing resistance of antibiotics to S. typhi.

This is impacting the choice of drugs available to treat typhoid. In recent years, for example, typhoid has become resistant to trimethoprim-sulfamethoxazole and ampicillin.

Ciprofloxacin, one of the key medications for typhoid, is also experiencing similar difficulties. Some studies have found Salmonella typhimurium resistance rates to be around 35 percent.

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