Typhoid fever 31596 225795302 2008-07-15T13:03:32Z Alfarq 6802811 /* External links */ {{for|a similar disease with a similar name|typhus}} {{for|a related disease which is caused by 2 different bacterium|Paratyphoid fever}} {{for|the character in the 2005 film [[Elektra (2005 film)|Elektra]]|Typhoid (Elektra)}} {{Infobox_Disease | Name = Typhoid fever | Image = Salmonella typhi.jpg | Caption = ''[[Salmonella]]'' typhi bacteria | DiseasesDB = 27829 | ICD10 = {{ICD10|A|01|0|a|00}} | ICD9 = {{ICD9|002}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = oph | eMedicineTopic = 686 | eMedicine_mult = {{eMedicine2|med|2331}} | MeshID = D014435 | }} '''Typhoid fever''', also known as '''enteric fever''', '''bilious fever''' or '''Yellow Jack''',<ref>Kotton C. Typhoid fever. [[MedlinePlus]]. URL: [http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm]. Accessed on: May 4, 2007.</ref> is an illness caused by the [[bacterium]] [[Salmonella typhi|''Salmonella enterica'' serovar Typhi]]. <!-- NOTE: This "odd" nomenclature is, in fact, correct. See [[Salmonella enterica]] entry for details. -->Common worldwide, it is transmitted by the ingestion of food or water contaminated with [[feces]] from an infected person.<ref name=Baron>{{cite book | author = Giannella RA | chapter = Salmonella | title = Baron's Medical Microbiology ''(Baron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1221 | isbn = 0-9631172-1-1 }}</ref> The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. Salmonella Typhi then alters its structure to resist destruction and allow them to exist within the macrophage. This renders them resistant to damage by PMN's, complement and the immune response. The organism is then spread via the lymphatics while inside the macrophages. This gives them access to the Reticulo-Endothelial System and then to the different organs throughout the body. The organism is a [[Gram-negative bacteria|Gram-negative]] short bacillus that is motile due to its peritrichous [[Flagellum|flagella]]. The bacteria grows best at 37°C (human body temperature). ==Symptoms== Typhoid fever is characterized by a sustained [[fever]] as high as 40°C (104°F), profuse sweating, [[gastroenteritis]], and nonbloody [[diarrhea]]. Less commonly a [[rash]] of flat, rose-colored spots may appear.<ref> {{cite web|url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm |title=CDC Typhoid Fever |accessdate=2007-10-02 |date=2005-10-25 |publisher=Center for Disease Control }}</ref> Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative [[bradycardia]], malaise, headache and cough. [[Epistaxis]] is seen in a quarter of cases and abdominal pain is also possible. There is [[leukopenia]] with [[eosinopenia]] and relative [[lymphocytosis]], a positive diazo reaction and blood cultures are positive for Salmonella Typhi or Paratyphi. The classic [[Widal test]] is negative in the first week. In the second week of the infection, the patient lies prostrated with high fever in plateau around 104°F (40°C) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around 1/3 patients. There are [[rhonchi]] in lung bases. The abdomen is distended and painful in the right lower quadrant where [[borborygmi]] can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea-soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender and there is elevation of liver [[transaminases]]. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. In the third week of typhoid fever a number of complications can occur: * Intestinal hemorrhage due to bleeding in congested [[Peyer's patches]]; this can be very serious but is usually non-fatal. * Intestinal perforation in distal [[ileum]]: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until [[septicaemia]] or diffuse [[peritonitis]] sets in. * [[Encephalitis]] * Metastatic abscesses, [[cholecystitis]], [[endocarditis]] and [[osteitis]] The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week [[defervescence]] commences that prolongs itself in the fourth week. ==Diagnosis== Diagnosis is made by [[blood culture|blood]], [[bone marrow]] or [[stool]] cultures and with the [[Widal test]] (demonstration of salmonella [[antibody|antibodies]] against [[antigens]] [[O-somatic]] and [[H-flagellar]]). In [[epidemic]]s and less wealthy countries, after excluding [[malaria]], [[dysentery]] or [[pneumonia]], a therapeutic trial time with [[chloramphenicol]] is generally undertaken while awaiting the results of Widal test and blood cultures.<ref name=Sherris>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | isbn = 0838585299 }}</ref> ==Treatment== [[Image:John Vachon Inoculation.jpg|right|thumb|Doctor administering a typhoid vaccination at a school in San Augustine County, Texas. Photograph by [[John Vachon]], April 1943.]] Typhoid fever in most cases is not 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%. When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. ===Resistance=== Resistance to 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 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 centres 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&ndash;1.0 mg/l) would not be picked up by this method.<ref>{{cite journal | title=Fluoroquinolone resistance in ''Salmonella'' Typhi (letter) | author=Cooke FJ, Wain J, Threlfall EJ | journal=Brit Med J | year=2006 | volume=333 | issue=7563 | pages=353&ndash;4 | doi = 10.1136/bmj.333.7563.353-b <!--Retrieved from CrossRef by DOI bot-->}}</ref> It not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent disc testing and cannot test for MICs. == Prevention == Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only from human to human. Typhoid can only spread in environments where human faeces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are therefore crucial to preventing typhoid. There are two vaccines currently recommended by the [[World Health Organisation]] for the prevention of typhoid<ref>{{cite journal|author=World Health Organization|year=2008|journal=Weekly Epidemiological Record|volume=83|issue=6|pages=49–60|title=Typhoid vaccines: WHO position paper|url=http://www.who.int/wer}}</ref>: these are the live, oral [[Ty21a]] vaccine (sold as ''Vivotif Berna'') and the injectable [[Vi capsular polysaccharide vaccine]] (sold as ''Typhim Vi''). Both are between 50 to 80% protective and are recommended for travellers to areas where typhoid is endemic. There exists an older killed whole-cell vaccine that is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use, because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection).<ref>{{cite journal|author=World Health Organisation|title=Typhoid vaccines: WHO position paper|year=2008|journal=Weekly epidemiological record|volume=83|issue=6|pages=49&ndash;60}}</ref> ==Transmission== [[Image:Typhoid stats.gif|thumb|right|Death rates for Typhoid Fever in the U.S. 1906&ndash;1960]] Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Public education campaigns encouraging people to wash their hands after toileting and before handling food are an important component in controlling spread of the disease. According to statistics from the United States [[Center for Disease Control]], the [[chlorination]] of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S. A person may become an [[asymptomatic carrier]] of typhoid fever, suffering no symptoms, but capable of infecting others. According to the [[Centers for Disease Control]] approximately 5% of people who contract typhoid continue to carry the disease after they recover. The most famous asymptomatic carrier was [[Typhoid Mary]]. She was a young cook that was responsible for infecting about 47 people during her lifetime, killing three of the infected. This was the first time a perfectly healthy person was known to be responsible for an "epidemic". ==[[Epidemiology]]== With an estimated 16-33 million cases of annually resulting in 500,000 to 600,000 deaths in endemic areas, the [[World Health Organisation]] identifies typhoid as a serious public health problem. Its incidence is highest in children between 5 and 19 years old.<ref name="who">{{cite web | title = Typhoid Fever | publisher = World Health Organisation | url = http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html | accessdate = 2007-08-28}}</ref> ==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 [[Cystic fibrosis transmembrane conductance regulator|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== Around 430–426 B.C., a devastating [[pandemic|plague]], which some believe to have been typhoid fever, killed one third of the population of [[History of Athens|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 he 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 2006 study detected [[DNA]] sequences similar to those of the bacterium responsible for typhoid fever.<ref name=Papagrigorakis_2006>{{cite journal | author=Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E | title=DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens | journal=Int J Infect Dis | year=2006 | pages=206–14 | volume=10 | issue=3 | pmid=16412683} }}</ref> Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.<ref name=Shapiro_2006>{{cite journal |author=Shapiro B, Rambaut A, Gilbert M |title=No proof that typhoid caused the Plague of Athens (a reply to Papagrigorakis et al.) |journal=Int J Infect Dis |volume=10 |issue=4 |pages=334–5; author reply 335–6 |year=2006 |pmid=16730469 | doi = 10.1016/j.ijid.2006.02.006 <!--Retrieved from CrossRef by DOI bot-->}}</ref> The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of [[Attica]] was besieged within the [[Long Walls]] and lived in tents. In the late 19th century, typhoid fever mortality rate in [[Chicago]] averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 persons.<ref name=CPL>{{cite web | title=1900 Flow of Chicago River Reversed | work=Chicago Timeline | url=http://www.chipublib.org/004chicago/timeline/riverflow.html | publisher = Chicago Public Library | accessdate=2007-02-08}}</ref> The most notorious carrier of typhoid fever—but by no means the most destructive—was [[Mary Mallon]], also known as Typhoid Mary. In [[1907]], she became the first [[United States|American]] carrier to be identified and traced. She was a cook in [[New York]]; some believe she was the source of infection for several hundred people. She is closely associated with forty-seven cases and three deaths.<ref name=Nova>{{cite web | title=Nova: The Most Dangerous Woman in America | url=http://www.pbs.org/wgbh/nova/typhoid/letter.html}}</ref> 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 [[Pseudonym|false name]]. She was detained and [[quarantine]]d after another typhoid outbreak. She died of pneumonia after 26 years in quarantine. In 1897, [[Almroth Edward Wright]] developed an effective vaccine. Most developed countries saw declining rates of typhoid fever throughout first half of 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. At the present time, incidence of typhoid fever in developed countries is around 5 cases per 1,000,000 people per year. An outbreak in the [[Democratic Republic of Congo]] in 2004-05 recorded more than 42,000 cases and 214 deaths.<ref name="who"/> === Famous typhoid victims === <!-- 25 September 2006. add Reports of Osama bin Laden's death due to "Typhoid" are conjectural at this point. [[WP:NOT|Wikipedia is not a news sources, nor a crystal ball]]. Please refrain from adding him to the List of typhoid victims until solid confirmation has occurred --> <!-- Please do not add individuals for whom no Wikipedia article exists, or where typhoid is not listed as the definitive cause of death --> Famous people who have had the disease include: * [[Abigail Adams]], wife of former United States President [[John Adams]] * [[Jean Baudrillard]], cultural theorist, sociologist and philosopher * [[Arnold Bennett]], [[novelist]] * [[Belle Boyd]], female confederate spy * [[Gonville Bromhead]], Victoria Cross recipient for actions during Battle of Rorke's Drift * [[John Buford]] * [[Martha Bulloch]], mother of [[Theodore Roosevelt]] * [[Stephen A. Douglas]], [[US]] [[politician]] * [[Anne Frank]], Holocaust victim * [[Alexander Alexandrovich Friedman]] * [[Mark Hanna]], [[US]] [[politician]] * [[Gerard Manley Hopkins]], English poet * [[Archduke Karl Ludwig of Austria]] * [[Mary Henrietta Kingsley]] * [[William Wallace Lincoln]], son of [[Abraham Lincoln]] * [[Joseph Lucas]] * [[James Martin (Australian soldier)]], Youngest known ANZAC * [[Frank McCourt]], contracted typhoid fever during his childhood, but survived * [[Albert of Saxe-Coburg-Gotha]], British [[prince consort]], [[Queen Victoria]]'s husband * [[Franz Schubert]], composer * [[Joseph Smith Jr.]], first Prophet of The Church of Jesus Christ of Latter Day Saints (also known as [[Mormons]]), contracted typhoid fever during childhood (7 years old), but survived * [[Leland Stanford, Jr.]] * [[Henry Frederick Stuart]], [[Prince of Wales]], original heir to the throne of [[James I of England]] * [[George Warrington Steevens]], [[journalist]] and [[writer]] * [[Evangelista Torricelli]] * [[Godfrey Weitzel]], [[major general]] in the [[Union army]] during the [[American Civil War]] * [[Wilbur Wright]], brother of [[Orville Wright]] * [[Ignacio Zaragoza]] ==Fictional People== *Ellen O'Hara, (Scarlett's mother from "[[Gone With the Wind]]"), Suellen O'Hara and Carreen O'Hara (Scarlett's sisters) suffer from Typhoid fever. *[[Gilbert Blythe]] (of the Anne of Green Gables Series) almost dies of Typhoid fever in "[[Anne of the Island]]," by L.M. Montgomery. *[[Walter Blythe]] (son of Anne and Gilbert Blythe in the latter Anne of Green Gables books)was in recovery of Typhoid in "Rilla of Ingleside" and is seen as the reason why he doesn't enlist at the onset of WWI. *Johann "Hanno" Buddenbrook, in [[Thomas Mann]]'s novel, ''[[Buddenbrooks]]'', dies of typhoid fever, and the book includes a long medical description of the disease and its effects. ==See also== *[[Frederick F. Russell]] *[[Typhoid Mary]] *[[Mary Mallon]] ==References== {{Reflist|2}} ===Further reading=== * ''Gale's Encyclopedia of Medicine'', published by Thomas Gale in 1999, ISBN ==External links== {{commons|Typhoid fever}} {{commons|Category:Salmonella}} * {{cite web | author = | year = | url = http://www.netdoctor.co.uk/travel/diseases/typhoid.htm | title = www.netdoctor.co.uk | format = | work = Article on typhoid fever for travelers | publisher = | accessdate = 17 February | accessyear = 2006 }} *[http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm United States Center for Disease Control and Prevention Listing] * {{cite web | author = Harrison, Noel G. | year = 2004 | url = http://www.healthsystem.virginia.edu/internet/library/historical/medical_history/typhoid/ | title = www.healthsystem.virginia.edu | format = | work = Historical exhibit on efforts by US Army to control typhoid fever | publisher = | accessdaymonth = 4 July | accessyear = 2006 }} * {{cite web | author = | year = | url = http://www.medicalnewstoday.com/medicalnews.php?newsid=36578 | title = www.medicalnewstoday.com | format = | work = Article on typhoid fever and the fall of Athens | publisher = | accessdaymonth = 17 February | accessyear = 2006 }} *[http://news.bbc.co.uk/2/hi/uk_news/scotland/7471198.stm Typhoid left city 'under siege'] [[BBC News]] {{Bacterial diseases}} [[Category:Bacterial diseases]] [[Category:Conditions diagnosed by stool test]] [[af:Ingewandskoors]] [[br:Terzhienn-domm]] [[bg:Коремен тиф]] [[da:Tyfus]] [[de:Typhus]] [[es:Fiebre tifoidea]] [[eu:Sukar tifoide]] [[fr:Fièvre typhoïde]] [[hr:Trbušni tifus]] [[id:Demam tifoid]] [[ia:Typhoide]] [[it:Tifo addominale]] [[he:טיפוס הבטן]] [[la:Typhus (morbus)]] [[ms:Demam kepialu]] [[nl:Buiktyfus en paratyfus]] [[ja:腸チフス]] [[no:Tyfoidfeber]] [[pl:Dur brzuszny]] [[pt:Febre tifóide]] [[ru:Брюшной тиф]] [[simple:Typhoid]] [[fi:Lavantauti]] [[sv:Tyfoidfeber]] [[zh:傷寒]]