Typhoid fever, also known as Enteric
Fever or commonly just typhoid, is a common worldwide illness, transmitted
by the ingestion of food or water contaminated with the feces of
an infected person.
fever is an acute illness associated with fever caused by bacteria.
It can also be caused by Salmonella paratyphi, a related bacterium
that usually causes a less severe illness. The bacteria are deposited
in water or food by a human carrier and are then spread to other
people in the area.
Typhoid fever is contracted by the ingestion of the bacteria
in contaminated food or water.
Patients with acute illness can contaminate the surrounding
water supply through stool, which contains a high concentration
of the bacteria.
Contamination of the water supply can, in turn, spoil the food
supply. About 3%-5% of patients become carriers of the bacteria
after the acute illness.
Some patients suffer a very mild illness that goes unrecognized.
These patients can become long-term carriers of the bacteria.
The bacteria multiply in the gallbladder, bile ducts, or liver
and passes into the bowel. The bacteria can survive for weeks
in water or dried sewage.
These chronic carriers may have no symptoms and can be the source
of new outbreaks of typhoid fever.
fever is characterized by a slowly progressive 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.
Classically, the course of untreated typhoid fever is divided
into four individual stages, each lasting approximately one
In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody
nose is seen in a quarter of cases and abdominal pain is also
There is leucopenia, a decrease in the number of circulating
white blood cells, with eosinopenia and relative lymphocytosis,
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 40 °C (104 °F) and
bradycardia and palpitation.
Delirium is frequent, frequently calm, but sometimes agitated.
Rose spots appear on the lower chest and abdomen in around 1/3
abdomen is distended and painful in the right lower quadrant.
Diarrhea can occur in this stage: six to eight stools in a day,
green with a characteristic smell. However, constipation is
The spleen and liver are enlarged and tender.
The Widal reaction is strongly positive.
Blood cultures are sometimes still positive at this stage. In
the third week of typhoid fever a number of complications can
incubation period is usually one to two weeks and the duration
of the illness is about four to six weeks. The patient experiences:
Generalized aches and pains
Diagnosis is made by any blood, bone marrow or stool cultures
and with the Widal test.
In epidemics 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 cultures of the blood and stool.
Typhoid fever is treated with antibiotics which kill the Salmonella
With antibiotics and supportive care, mortality has been reduced
to 1%-2%. With appropriate antibiotic therapy, there is usually
improvement within one to two days and recovery within seven
to 10 days.
The choice of antibiotics needs to be guided by identifying
the geographic region where the organism was acquired and the
results of cultures once available.
The carrier state, which occurs in 3%-5% of those infected,
can be treated with prolonged antibiotics. Often, removal of
the gallbladder, the site of chronic infection, will cure the
For those traveling to high-risk areas, vaccines are now available.