Typhoid Fever

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.

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.

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

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.