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Typhoid (Salmonella enterica)

What is Typhoid?
Typhoid fever is an infection caused by a strain of bacteria called Salmonella typhii, which is related to the bacteria that causes salmonella food poisoning. The infection can affect the whole body and damage multiple organs. Unless treated, this infection can have life threatening consequences.


Causes of typhoid fever:
Typhoid fever is caused by a type of bacteria called Salmonella typhi.
This isn’t the same bacteria that cause salmonella food poisoning, but the two are related.

How the infection spreads:

The Salmonella typhi bacteria will be in the stools (poo) of an infected person after they’ve been to the toilet. If they don’t wash their hands properly afterwards, they can contaminate any food they touch. Anyone else who eats this food may also become infected.
Less commonly, the Salmonella typhi bacteria can be passed out in an infected person’s urine. Again, if an infected person handles food without washing their hands properly after urinating, they can spread the infection to someone else who eats the contaminated food.
In parts of the world with poor sanitation, infected human waste can contaminate the water supply. People who drink contaminated water or eat food washed in contaminated water can develop typhoid fever.

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Other ways typhoid fever can be contracted include:
Using a toilet contaminated with bacteria and touching your mouth before washing your hands
eating seafood from a water source contaminated by infected faeces or urine eating raw vegetables that have been fertilised with human waste contaminated milk products having oral or anal sex with a person who’s a carrier of Salmonella typhi bacteria.

Carriers Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the infection. This means the Salmonella typhi bacteria continue to live in the carrier’s body and can be spread as normal in faeces or urine, but the carrier doesn’t have any noticeable symptoms of the condition.

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Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease.
Early illness
Once signs and symptoms do appear, you’re likely to experience:
Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
Weakness and fatigue
Muscle aches
Dry cough
Loss of appetite and weight loss
Abdominal pain
Diarrhea or constipation
Extremely swollen abdomen

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Later illness:
If you don’t receive treatment, you may:
Become delirious
Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state
In addition, life-threatening complications often develop at this time.
In some people, signs and symptoms may return up to two weeks after the fever has subsided.
When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you’ll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.
If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn’t familiar with these areas.

Typhoid is a severe, infectious and life-threatening disease. It is spread through unhygienic food, drinks and water where bacteria S.typhi develop which make person ill. Person who consume contaminated water exhibit symptoms of fever with severe complications. Various drugs used to treat typhoid are unsuccessful against resistant strains of typhoid bacteria. In developing country such as India, it is a great threat and a major cause of death. Typhoid disease mainly hit on children who are in school-going age. It is not very common in adults and older people.

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Typhoid is a communicable disease and it is transmitted in many ways in India. Bacteria of typhoid are survived in unhygienic conditions. These bacteria are spread by typhoid patients and carriers in large quantities through stools and vomit. The bacteria then travel to food, drinks and water through house-flies and other insects. Such foods are contaminated. When these contaminated food or drinks, are taken by healthy person, bacteria enter in to the body of person and causes typhoid fever. Person may get typhoid fever by consuming food or drink that has been carried by someone having the bacteria, or if sewage contaminated with S. typhi gets into water used for drinking or washing food. A person infected with S.typhi may infect others, as the bacteria remain in the body for months. There are 107 different strains of this bacterium. Paratyphoid is caused by Salmonella enteritidis paratyphi A, B or C. It is generally a less infection than typhoid. A very low percent of typhoid patients remain chronic carriers regardless of treatment. Most common complications are intestinal bleeding and perforation. The source of fever is polluted water. In India, due to population explosion, water is polluted and this disease is matter of worry especially in disaster areas, where water supply and sewage disposal are disrupted. Raw vegetables grown on sewage fields also spread infection. The bacteria can survive in soil and water for several months. They grow rapidly in milk and milk-products. Unhygienic conditions in surroundings are mainly responsible for the prevalent infection.

Diagnosing typhoid fever:

You should see your GP if you think you have typhoid fever, particularly if you’ve recently returned from travelling abroad.
Your GP will want to know whether you’ve travelled to parts of the world where the infection is present, or whether you’ve been in close contact with someone who’s travelled to these areas.
Parts of the world where the infection is most common include the Indian subcontinent, Africa, South East Asia and South America.

Testing for typhoid fever:
A diagnosis of typhoid fever can usually be confirmed by analysing samples of blood, stools or urine. These will be examined under a microscope for the Salmonella typhi bacteria that cause the condition.

The bacteria aren’t always detected the first time, so you may need to have a series of tests.

Testing a sample of bone marrow is a more accurate way of diagnosing typhoid fever. However, getting the sample is both time-consuming and painful, so it’s usually only used if other tests are inconclusive.

If typhoid fever is confirmed, other members of your household may also need to be tested, in case you’ve passed the infection on to them

A complete blood count (CBC) will show a high number of white blood cells.

A blood culture during the first week of the fever can show S. typhibacteria.

Other tests that can help diagnose this condition include:
ELISA urine test to look for the bacteria that cause Typhoid fever Fluorescent antibody study to look for substances that are specific to Typhoid bacteria.

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Platelet count (platelet count may be low).

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Stool culture.


Treatments and drugs:
Antibiotic therapy is the only effective treatment for typhoid fever.
Commonly prescribed antibiotics
Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for nonpregnant adults.
Ceftriaxone (Rocephin). This injectable antibiotic is an alternative for people who may not be candidates for ciprofloxacin, such as children.
These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.
Problems with antibiotic resistance
In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of side effects, a high rate of health deterioration after a period of improvement (relapse) and widespread bacterial resistance.
In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid fever, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin.

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Other treatments:

Other treatments include:
Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein (intravenously).
Surgery. If your intestines become perforated, you’ll need surgery to repair the hole.

Typhoid 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 – live, attenuated vaccine. Consists of 4 tablets – one taken every other day, the last of which is taken 1 week before travel.
Shot – inactivated vaccine, administered 2 weeks before travel.
Note: 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.
There may be side effects to the vaccine:
Shot: fever (1 in 100 cases)
Shot: headache (1 in 30 cases)
Shot: redness or swelling at the site of injection (1 in 15 cases)
Oral: fever or headache (1 in 20 cases)
Oral: stomach pain, nausea, vomiting, rash (rare)
Even when the symptoms of typhoid have passed, it is still possible to be carrying the bacteria. As a result, it is difficult to entirely stamp out the disease because carriers whose symptoms have finished may stop showing caution when washing food or interacting with others.
Although there are two types of typhoid vaccine available, 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.
Regardless of efficacy, treating children in risky areas with current vaccines would be of benefit. Unfortunately, because of their relatively high cost, governments are reluctant to adopt them.

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In many developing nations, the public health goals that can help prevent and control typhoid fever — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
A vaccine is recommended if you’re traveling to areas where the risk of getting typhoid fever is high.

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Two vaccines are available:
One is injected in a single dose at least one week before travel.

One is given orally in four capsules, with one capsule to be taken every other day.

Neither vaccine is 100 percent effective, and both require repeat immunizations, as vaccine effectiveness diminishes over time.

Because the vaccine won’t provide complete protection, follow these guidelines when traveling to high-risk areas:

Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection.

Wash before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.

Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is.

Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.

Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.

Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.

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Prevent infecting others:
If you’re recovering from typhoid fever, these measures can help keep others safe:
Take your antibiotics. Follow your doctor’s instructions for taking your antibiotics, and be sure to finish the entire prescription.

Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.

Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.