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Typhoid fever

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 culture during first week of the fever can show S. typhi bacteria

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.

Support Groups

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.