Typhoid Fever

Typhoid fever is an acute bacterial disease caused by Salmonella typhi. Typhoid germs are passed in the feces and, to some extent, the urine of infected people. The germs are spread by eating or drinking water or food contaminated by feces (or urine) from the infected individual.

Symptoms and disease course

Symptoms generally appear one to three weeks after exposure. In its early stages typhoid resembles many other illnesses, and often sufferers may feel like they have a bad cold or flu on the way. The onset of typhoid fever is normally gradual, with fever, malaise, chills, headache, generalized aches in the muscles and joints, tiredness, loss of appetite, and sore throat. Abdominal pain and distension may occur. Vomiting, which may occur toward the end of the first week, is not usually severe. Diarrhea is infrequent; constipation occurs more often than diarrhea.

A fever develops which rises a little each day until it is around 104 degrees Fahrenheit or more. The person's pulse is often slow relative to the degree of fever present and gets slower as the fever rises, unlike a normal fever where the pulse increases.

In the second week, the high fever and slow pulse continue and a few pink spots may appear on the body. Trembling, delirium, weakness, weight loss and dehydration are other symptoms. "Pea soup" diarrhea may occur. Abdominal pain and distension may be increased. If there are no further complications, the fever and other symptoms will slowly diminish during the third week. However, typhoid is a very dangerous infection and an infected individual must get medical help as soon as possible, because pneumonia or peritonitis (perforated bowel) are common complications.

Diagnosis comes from isolation of Salmonella typhi from the blood or stool of an infected person.

The best protection is to avoid consuming food or water that may be contaminated. For foreign travelers, drinking only boiled water or carbonated beverages and eating only cooked food, lowers the risk of infection.

Treatment

The fever should be treated by keeping the victim cool, and dehydration should also be watched for. Treatment is with ampicillin, chloramphenicol, Bactrim, or Cipro, depend ing upon the clinical circumstances. Chloramphenicol is the most effective drug for treatment of the acute illness, if the organism is not resistant. If hospital facilities are not close by, consider starting treatment with Cipro. Ampicillin and amoxicillin are effective alternatives.

Fatalities are less than 1 percent with antibiotic treatment. Even after effective treatment, you may continue to carry typhoid bacteria in your intestinal tract, which can be passed to close contacts such as family members. Follow-up testing is very important. Relapses are common, and the frequency of relapse does not appear to have been changed dramatically by antibiotic therapy.

Vaccination

Vaccines are available that afford significant protection. Currently available vaccines have been shown to protect 70% - 90% of the recipients. Therefore, even vaccinated travelers should be cautious in selecting their food and water.

The oral vaccine consists of 4 capsules containing live attenuated bacteria. They are taken every other day for seven days. The oral vaccine is effective for travelers to infected areas for five years. The entire 4 doses should be repeated every 5 years if the person is at continued risk. Reactions are rare and include nausea, vomiting, abdominal cramps, and skin rash.

The injectable vaccine consists of a primary series of two shots, spaced at least 4 weeks apart. A booster dose given every 3 years provides continued protection for repeated exposure. If there is insufficient time for two doses a month apart, an accelerated schedule of three shots a week apart may be administered. The accelerated schedule may be less effective.

CDC

CDC recommends a typhoid vaccination for those travelers who are going off the usual tourist itineraries, traveling to smaller cities and rural areas, or staying for six weeks or more. Typhoid vaccination is not required for international travel.

Diseases