Typhoid fever, also known as typhoid,[1] is a common worldwide illness, transmitted by the

ingestion of food or water contaminated with the feces of an infected person, which contain the
bacterium Salmonella typhi.[2][3] The bacteria then perforate through the intestinal wall and are
phagocytosed by macrophages. The organism is a Gram-negative short bacillus that is motile due
to its peritrichous flagella. The bacterium grows best at 37 °C/99 °F – human body temperature.
This fever received various names, such as gastric fever, abdominal typhus, infantile
remittant fever, slow fever, nervous fever, pythogenic fever, etc. The name of " typhoid " was
given by Louis in 1829, as a derivative from typhus.
The impact of this disease falls sharply with the application of modern sanitation techniques.

Signs and symptoms

Typhoid 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.[4]
Classically, the course of untreated typhoid fever is divided into four individual stages, each
lasting approximately one week. In the first week, there is a slowly rising temperature with
relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter
of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of
circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo
reaction and 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 prostrate with high fever in plateau around
40 °C (104 °F) and bradycardia (sphygmothermic dissociation), classically with a dicrotic pulse
wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to
typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in
around a third of patients. There are rhonchi in lung bases. The abdomen is distended and painful
in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six
to eight stools in a day, green with a characteristic smell, comparable to pea soup. However,
constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender,
and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO
and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major
symptom of this fever is the fever usually rises in the afternoon up to the first and second week.)
In the third week of typhoid fever, a number of complications can occur:
• Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very
serious but is usually not fatal.
• Intestinal perforation in the distal ileum: this is a very serious complication and is
frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse
peritonitis sets in.
• Encephalitis
 • Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the
patient is delirious (typhoid state). By the end of third week the fever has started reducing this
(defervescence). This carries on into the fourth and final week.

[edit] Cause
[edit] Transmission
Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene
habits and public sanitation conditions. Public education campaigns encouraging people to wash
their hands after defecating and before handling food are an important component in controlling
spread of the disease. According to statistics from the United States Centers for Disease Control
and Prevention (CDC), the chlorination of drinking water has led to dramatic decreases in the
transmission of typhoid fever in the U.S.
A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but
capable of infecting others. According to the CDC approximately 5% of people who contract
typhoid continue to carry the disease after they recover. The most famous asymptomatic carrier
was Mary Mallon (commonly known as "Typhoid Mary"), a young cook who was responsible
for infecting at least 53 people with typhoid, three of whom died from the disease.[5] Mallon was
the first apparently perfectly healthy person known to be responsible for an "epidemic".
Many carriers of typhoid were locked into an isolation ward never to be released in order to
prevent further typhoid cases. These people often deteriorated mentally, driven mad by the
conditions they lived in.[6]

[edit] Heterozygous advantage

It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the
heterozygous advantage that it confers against typhoid fever.[7] The CFTR protein is present in
both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR
protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.

[edit] Diagnosis of typhoid

Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test
(demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). 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.[8]
The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.[9]

[edit] Prevention