What you need to know

about typhoid
Last updated Mon 4 December 2017
By Tim Newman
Reviewed by University of Illinois-Chicago, School of Medicine

1. What is typhoid?

2. Symptoms

3. Treatment

4. Causes

5. Diet

6. Prevention
Typhoid is a bacterial infection that can lead to a high fever, diarrhea, and
vomiting. It can be fatal. It is caused by the bacteria Salmonella typhi.
The infection is often passed on through contaminated food and drinking
water, and it is more prevalent in places where handwashing is less
frequent. It can also be passed on by carriers who do not know they carry
the bacteria.

Annually, there are around 5,700 cases in the United States, and 75
percent of these start while traveling internationally. Globally, around 21.5
million people a year contract typhoid.

If typhoid is caught early,it can be successfully treated with antibiotics;if is

not treated ,typhoid can be fatal
 . Symptoms
Symptoms normally begin between 6 and 30 days after exposure to the bacteria.

The two major symptoms of typhoid are fever and rash. Typhoid fever is
particularly high, gradually increasing over several days up to 104 degrees
Fahrenheit, or 39 to 40 degrees Celsius.

The rash, which does not affect every patient, consists of rose-colored spots,
particularly on the neck and abdomen.

Other symptoms can include:

 weakness

 abdominal pain

 constipation

 headaches
Rarely, symptoms might include confusion, diarrhea, and vomiting, but this is not
normally severe.

In serious, untreated cases, the bowel can become perforated. This can lead to
peritonitis, an infection of the tissue that lines the inside of the abdomen, which has
been reported as fatal in between 5 and 62 percent of cases.

Another infection, paratyphoid, is caused by Salmonella enterica. It has similar

symptoms to typhoid, but it is less likely to be fatal.
Typhoid is an infection caused by Salmonella typhimurium bacteria that is spread from human to human.
 What is typhoid ?Typhoid is
an infection caused by the bacterium Salmonella
typhimurium (S. typhi).
The bacterium lives in the intestines and bloodstream of humans. It
spreads between individuals by direct contact with the feces of an infected
person.

No animals carry this disease, so transmission is always human to human.

, fewer than 4 in 100 cases are fatal.

S. typhi enters through the mouth and spends 1 to 3 weeks in the intestine.
After this, it makes its way through the intestinal wall and into the
bloodstream.

From the bloodstream, it spreads into other tissues and organs. The
immune system of the host can do little to fight back because S. typhi can
live within the host's cells, safe from the immune system.

Typhoid is diagnosed by detecting the presence of S. typhi via blood, stool,

urine, or bone marrowsample.

Symptoms normally begin between 6 and 30 days after exposure to the

bacteria.

The two major symptoms of typhoid are fever and rash. Typhoid fever is
particularly high, gradually increasing over several days up to 104 degrees
Fahrenheit, or 39 to 40 degrees Celsius.

The rash, which does not affect every patient, consists of rose-colored
spots, particularly on the neck and abdomen.
 Other symptoms can include:

 weakness

 abdominal pain

 constipation

 headaches
Rarely, symptoms might include confusion, diarrhea, and vomiting, but this
is not normally severe.

In serious, untreated cases, the bowel can become perforated. This can
lead to peritonitis, an infection of the tissue that lines the inside of the
abdomen, which has been reported as fatal in between 5 and 62 percent of
cases.

Another infection, paratyphoid, is caused by Salmonella enterica. It has

similar symptoms to typhoid, but it is less likely to be fatal.


Commented [AK1]:

Treatment
The only effective treatment for typhoid is antibiotics. The most commonly used
are ciprofloxacin (for non-pregnant adults) and ceftriaxone.

Other than antibiotics, it is important to rehydrate by drinking adequate water.

In more severe cases, where the bowel has become perforated, surgery may be
required.

Typhoid antibiotic resistance

As with a number of other bacterial diseases, there is currently concern about the
growing resistance of antibiotics to S. typhi.
This is impacting the choice of drugs available to treat typhoid. In recent years, for
example, typhoid has become resistant to trimethoprim-sulfamethoxazole and
ampicillin.

Ciprofloxacin, one of the key medications for typhoid, is also experiencing similar
difficulties. Some studies have found Salmonella typhimurium resistance rates to
be around 35 percent.

Causes
Typhoid is caused by the bacteria S. typhi and spread through food, drinks, and
drinking water that are contaminated with infected fecal matter. Washing fruit and
vegetables can spread it, if contaminated water is used.

Some people are asymptomatic carriers of typhoid, meaning that they harbor the
bacteria but suffer no ill effects. Others continue to harbor the bacteria after their
symptoms have gone. Sometimes, the disease can appear again.

People who test positive as carriers may not be allowed to work with children or
older people until medical tests show that they are clear.

Prevention
Countries with less access to clean water and washing facilities typically have a
higher number of typhoid cases.
 Vaccination

If traveling to an area where typhoid is prevalent, vaccination is recommended.

Before traveling to a high-risk area, getting vaccinated against typhoid fever is

recommended.

This can be achieved by oral medication or a one-off injection:

 Oral: a live, attenuated vaccine. Consists of 4 tablets, one to be taken every

second day, the last of which is taken 1 week before travel.

 Shot, an inactivated vaccine, administered 2 weeks before travel.

Vaccines are not 100 percent effective and caution should still be exercised when
eating and drinking.

Vaccination should not be started if the individual is currently ill or if they are
under 6 years of age. Anyone with HIV should not take the live, oral dose.
 The vaccine may have adverse effects. One in 100 people will experience a fever.
After the oral vaccine, there may be gastrointestinal problems, nausea, and
headache. However, severe side effects are rare with either vaccine.

There are two types of typhoid vaccine available, but a more powerful vaccine is
still needed. The live, oral version of the vaccine is the strongest of the two. After 3
years, it still protects individuals from infection 73 percent of the time. However,
this vaccine has more side effects.

The current vaccines are not always effective, and because typhoid is so prevalent
in poorer countries, more research needs to be done to find better ways of
preventing its spread.

Eliminating typhoid
Even when the symptoms of typhoid have passed, it is still possible to be carrying
the bacteria.

This makes it hard to stamp out the disease, because carriers whose symptoms
have finished may be less careful when washing food or interacting with others.

People traveling in Africa, South America, and Asia, and India in particular,
should be vigilant.

Avoiding infection
Typhoid is spread by contact and ingestion of infected human feces. This can
happen through an infected water source or when handling food.

The following are some general rules to follow when traveling to help minimize
the chance of typhoid infection:

 Drink bottled water, preferably carbonated.

 If bottled water cannot be sourced, ensure water is heated on a rolling boil for at
least one minute before consuming.
 Be wary of eating anything that has been handled by someone else.

 Avoid eating at street food stands, and only eat food that is still hot.

 Do not have ice in drinks.

 Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.
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