Typhoid fever is caused when the bacterium Salmonella typhi (a.k.a. salmonella, a Gram negative rod bacilus, from the family Enterobacteriaceae) which is spread by the faecal-oral route, leaves the intestine and multiplies throughout the body. Typhoid fever affects 17 million people worldwide every year, with approximately 600,000 deaths annualy. It is more common in less developed countries, especially where the level of hygiene is low, sanitation is poor and the population is not educated in proper food handling.

The usual symptoms in typhoid fever are sustained fever, severe headache, nausea, severe loss of appetite, constipation or sometimes diarrhoea -- and most commonly, a good combination of the above. Mortality rates of 10% have been known to be reduced to less than 1% with appropriate therapy.

If you're stuck in a developing country, to help avoid typhoid, boil drinking water and thoroughly clean and cook all food before consumption. Also, take precautions to dispose of all faeces in a sanitary manner to avoid contamination. A vaccine is also available but does not provide 100% immunity.

Typhoid is treated with antibiotics. Ampicillin, trimethoprim-sulfamethoxazole (Bactrim) and Ciprofloxacin have been known to work. Ciprofloxacin is currently the antibiotic of choice against typhoid.

What is typhoid fever?

Typhoid fever is a potentially life threatening disease caused by the bacterium Salmonella enterica Typhi.

How widespread is this disease?

Within the US, there is an average of 400 cases reported each year, and according to the CDC, approximately 70 percent of these are from international traveling. However, worldwide, there is an astonishing 16 million cases reported, with over 600,000 fatalities. (CDC)

Symptoms:

Sustained high fevers around 103° to 104° F (39° to 40° C), general weakness, loss of appetite, headache, bradycardia (a slowing of heart rate), constipation or diarrhea, enlarged spleen and liver, delirium, hallucinations, and in some cases rose colored spots on the trunk of ones body.

Where can I catch it?

In most industrialized countries, the presence of typhoid fever is extremely small, however, when one is traveling abroad, especially among developing countries, they should be more careful, because there is a higher chance of catching this disease.

How can I catch it?

Salmonella enterica Typhi lives only in humans, and is carried within the bloodstream or ones intestinal tract. Therefore, one can catch it from foods handled by a person that has small cuts on their hand, or hands that may be contaminated with sewage (feces and the like). Also, it can be caught through water that may be contaminated with sewage, which is later consumed by the unwitting traveler, whether from a glass of cold water, or the ice that is keeping your beer lightly chilled. Once you have the bacterium enter your body, it will begin to multiply and spread into your bloodstream, causing fever, and some of the symptoms above.

Sounds bad, how can I avoid it?

There are two ways of avoiding typhoid fever. First, you want to watch what you eat and drink, and just use common sense in avoiding risky foods. This would include anything not fully cooked, or water from a local source. The second precaution you could take is to get vaccinated against the bacterium. However, one should note that the vaccination is not completely effective, and precautions of food and drink should still be taken.

Here are some tips to remember when traveling abroad:

  • Boil your water for at least one minute to kill any bacterium before consumption.
  • Bottled water is your safest bet, and for reasons as of yet known to me, carbonated bottled water is apparently somehow safer than uncarbonated water. (according to the various sources checked). Other bottled beverages, such as soda and the like are safe as well.
  • Ask for your drink without ice, unless you know that the ice is made from either bottled water or boiled water.
  • Avoid any snow cones, ice pops and the like that may have been made with local, possibly contaminated water.
  • Eat foods that are fully cooked and still steaming. This would mean avoiding sushi and other raw delicacies.
  • Avoid raw fruits and vegetables that cannot be peeled by your own hands. These are easily contaminated and hard to get clean.
  • Avoid the foods from street vendors, as you cannot know just how clean it really is.

I want to get vaccinated, is there anything I should know?

Make sure that you get the vaccination at least one or two weeks in advance (depending on the type of vaccination) so it has time to take effect within your body. The vaccine will lose its effectiveness in a few years, so make sure to stay regular with the boosters if you plan on traveling a few years after your first vaccination.

Types of vaccination:

First we have Vivotif Berna, which is a capsule taken orally, 1 capsule every 2 days, with 4 capsules needed to complete the dose (8 days total). It will take 2 weeks for this vaccination to take effect, so take that into consideration before making plans. You need to be at least 6 years of age for this vaccination, and it will remain effective for 5 years. The capsules should be kept refrigerated, and taken at least 1 hour prior to a meal. See your doctor for further details, questions or comments regarding this treatment.

The second vaccination is Typhim Vi, an injection. There is only one dose needed, and it should be taken 1 week prior to your trip. You need to be at least 2 years of age for this vaccination, and it will last you for two years.

I do not have information as to which is cheaper, or any other information which is not listed here or of public domain. I am not a doctor. That being said, allow us to move on…

I think I have typhoid fever! What should I do?

You need to stop reading this node IMMEDIATELY and go see a doctor RIGHT NOW. If you are in a foreign country, call the US consulate to get a list of recommended doctors. Once at the doctor, they will most likely give you one of three antibiotics to treat the disease ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin. You should start to feel better within 2-3 days, and death is rare. However, left untreated, the fevers could last weeks or even months, and there is a 20 percent chance of death due to complications from the infection.

My symptoms cleared up! I’m cured, right?

Not necessarily. You can still be a carrier of the S. Typhi bacterium. If you do, you can relapse into illness, or infect others. The carrier stage can last from a few days to a number of years. Only around 3 percent of typhoid cases come to be lifelong carriers. What can you do to prevent being a carrier of this disease? Make sure that you follow through with your prescribed medicine, maintain an extra high level of personal hygiene (especially the washing of hands), and check up with your doctor regularly to be tested for the presence of the bacterium.




Sources:

CDC:

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm

New York State department of health:

http://www.health.state.ny.us/nysdoh/communicable_diseases/en/typh.htm

Utah department of health:

http://hlunix.hl.state.ut.us/els/epidemiology/epifacts/typhoid.html

Medline Plus:

http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm

Ty"phoid (?), a. [Typhus + -oid: cf. F. typhoide, Gr. . See Typhus.] Med.

Of or pertaining to typhus; resembling typhus; of a low grade like typhus; as, typhoid symptoms.

Typhoid fever, a disease formerly confounded with typhus, but essentially different from the latter. It is characterized by fever, lasting usually three or more weeks, diarrhaea with evacuations resembling pea soup in appearance, and prostration and muscular debility, gradually increasing and often becoming profound at the acme of the disease. Its local lesions are a scanty eruption of spots, resembling flea bites, on the belly, enlargement of the spleen, and ulceration of the intestines over the areas occupied by Peyer's glands. The virus, or contagion, of this fever is supposed to be a microscopic vegetable organism, or bacterium. Called also enteric fever. See Peyer's glands.<-- caused by the gram-negative bacillus, Salmonella typhosa (syn. Salmonella typhi), also called typhoid bacillus. The organism is often ingested by drinking contaminated water. --> -- Typhoid state, a condition common to many diseases, characterized by profound prostration and other symptoms resembling those of typhus.

 

© Webster 1913.

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