Alternative names
Enteric fever
Definition
Typhoid fever is a bacterial infection characterized by diarrhea, systemic disease, and a rash -- most commonly caused by the bacteria Salmonella typhi.
Causes, incidence, and risk factors
S. typhi are spread by contaminated food, drink, or water. Following ingestion, the bacteria spread from the intestine to the intestinal lymph nodes, liver, and spleen via the blood where they multiply.
Salmonella may directly infect the gallbladder through the
hepatic duct or spread to other areas of the body through the bloodstream.
Early symptoms are generalized and include fever, malaise and abdominal pain. As
the disease progresses, the fever becomes higher (greater than 103 degrees
Fahrenheit), and diarrhea becomes prominent. Weakness, profound fatigue,
delirium, and an acutely ill appearance develop.
A rash, characteristic only of typhoid and called "rose
spots," appears in some cases of typhoid. Rose spots are small (1/4 inch) red
spots that appear most often on the abdomen and chest. Typically, children have
milder disease and fewer complications than adults.
A few people can become carriers of S. typhi and continue to shed the
bacteria in their feces for years, spreading the disease, as in the case of
"Typhoid Mary" in New York over one hundred years ago.
Although typhoid fever is common in developing countries, less than 400 cases are reported in the U.S. each year, most brought in from abroad.
Symptoms
Severe headache
Fever
Loss of appetite
General discomfort, uneasiness, or ill feeling (malaise)
Rash (rose spots) appearing on the lower chest and abdomen during the second week of the fever
Abdominal tenderness
Constipation, then diarrhea
Stools, bloody
Slow, sluggish, lethargic
Fatigue
Weakness
Nosebleed
Chills
Delirium
Confusion
Agitation
Fluctuating mood
Difficulty paying attention (attention deficit)
Hallucinations
Signs and tests
An elevated white blood cell count in blood
A blood culture during first week of the fever can show S. typhi bacteria
A stool culture
An ELISA test on urine may show Vi antigen specific for the bacteria
A platelet count (decreased platelets)
A fluorescent antibody study (demonstrates Vi antigen, which is specific for typhoid)
Treatment
Intravenous fluids and electrolytes may be given. Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so the choice of antibiotics should be a careful one.
Expectations (prognosis)
The illness usually resolves in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop. Cases in children are milder, and are more debilitating in the elderly.
Relapse may occur if the treatment has not fully eradicated the infection.
Complications
Intestinal hemorrhage (severe GI bleeding)
Intestinal perforation
Kidney failure
Peritonitis