Although almost completely eradicated in the United States, typhoid fever is still a serious public health issue affecting approximately 21.5 million individuals in developing countries each year, according to the Centers for Disease and Control Prevention (CDC). Modern sanitation procedures and techniques and improved personal hygiene are the biggest reasons for the disappearance of typhoid fever in the United States and other industrialized nations. Despite the high number of individuals affected each year, typhoid fever is a treatable disease with a good outcome when detected early.
Identification
Typhoid fever is an infection by the bacterium Salmonella typhi. It is spread via the ingestion of food or drink contaminated by the feces of an infected individual. The bacteria initially takes up residence in the intestinal wall but can spread to other organs in the body. Individuals generally present with high fever and gastrointestinal problems. Typhoid fever is rare in industrialized countries but quite common in the developing world.
Symptoms
Upon infection, the symptoms of typhoid fever generally develop slowly over the course of one to three weeks. Symptoms are divided into four stages, generally lasting one week at a time. The most common symptoms are diarrhea, fever, headache, malaise and abdominal pain. A rash called a "rose spot" often develops on the belly or chest. The fever and diarrhea generally become more severe as the disease gets worse. Several complications can arise, with the most common being intestinal hemorrhaging and perforation, which can be serious and sometimes fatal. Less common symptoms include chills, confusion, hallucinations and delirium.
Risk Factors
Typhoid fever is endemic in India, South America, Africa and Southeast Asia. Individuals living or traveling to these places should take the necessary precautions to avoid infection. Children are at the greatest risk but generally have milder symptoms compared to adults. Other high-risk individuals are scientists and researchers working with Salmonella typhi bacteria, those with weakened immune systems, or those in close contact to infected individuals or carriers.
Diagnosis
A complete medical and travel history is the first step in diagnosing typhoid fever, followed by blood and culture tests. The most common way to identify typhoid fever is with a stool culture. In a stool culture, a sample of the stool is allowed to grow on a medium that promotes bacterial growth for several days, upon which identification of Salmonella typhi is detected with microbiological techniques. Other common tests include a white blood cell and platelet count, urine test, and a fluorescent antibody study to detect specific antibodies present in infected individuals.
Treatment
Typhoid fever has a good outcome when treated early with antibiotics but can be life-threatening without treatment. Depending on the severity of the disease, antibiotics are either administered orally or intravenously. Fluids and electrolytes are pushed to prevent dehydration due to diarrhea. Symptoms generally improve within two to four weeks of treatment. Antibiotic resistance is a continual problem with frequent antibiotic use and many of the antibiotics used in the past to treat typhoid fever have developed resistance and are no longer in use. Vaccinations are available for typhoid fever but are only partially effective.
Travelers
The CDC recommends several steps to reduce the risk of becoming infected with typhoid fever when traveling to high-risk countries. It is recommended to avoid risky foods such as tap water, raw food and any type of food sold by street vendors, unless proper sterilization techniques can be used. It is also recommended that all travelers get the typhoid fever vaccination at least one week before traveling.
