Information on the following diseases can be found in the Related Disorders section of this report:

• Salmonella
• Botulism
• Ptomaine Poisoning
• Cholera

Typhoid is an intestinal infection caused by the bacterium Salmonella typhi. Antibodies to the bacteria can be detected in the blood (Widal's test). Salmonella typhi can be cultured from the patient's blood, urine and feces as well. The infection incubates for one or two weeks. A gradual development of headache, loss of appetite, fatigue and constipation occurs. During the following weeks there is a gradual rise in temperature to about 104 F, abdominal pain, a slowed pulse rate, nosebleeds, rose-colored spots on the chest and diarrhea. Intestinal ulceration and bleeding can lead to anemia and peritonitis. These conditions may be fatal if the patient is left untreated. Heart failure may also occur.

Even after a complete recovery from Typhoid fever the patient may remain a carrier of the bacteria for a number of weeks, months or even years. Those who have had Typhoid should be very careful of personal hygiene and avoid handling food that other people eat until the bacteria is no longer present in the patient's feces.

Typhoid is caused by the bacterium Salmonella Typhi. It is the most serious of the Salmonella infections. Contaminated food or water is most often the source of a Typhoid outbreak. Contact with a carrier of the bacterium, polluted water, infected food or milk, shellfish harvested from polluted water, or fresh vegetables grown in contaminated soil are all sources of the Salmonella Typhi bacterium. People who have had Typhoid are "carriers" until the bacteria is completely gone from their body. If they touch food served to other people when their hands are not properly washed, they can spread Typhoid to those who eat the food.

Typhoid affects males and females in equal numbers. In the United States there are only about 500 cases of typhoid diagnosed each year, and over 62% of these are contracted in other countries. The major sources of cases in the United States between the years 1975-1984 were Mexico (39%) and India (14%). In Mexico, Latin America, Asia, Africa and the Middle East where the fatality rate is as high as 10% each year, typhoid is still a serious health problem. In the U.S., outbreaks are usually traced to a typhoid carrier in the food handling business (e.g. restaurants, hotels, etc.).

Centers for Disease Control (CDC) researchers investigated cases of typhoid fever diagnosed in the U.S. from June 1996 through May 1997. They found that, of the 282 cases for which complete clinical information exists, 81 percent involved foreign travel. (Typically, those who became ill were foreign visitors to the U.S. or foreign-born U.S. residents who had traveled recently to their native countries.) The part of the world most often implicated in this study was the Indian subcontinent. Half of the patients were younger than 21.

Symptoms of the following disorders can be similar to those of Typhoid fever. Comparisons may be useful for a differential diagnosis:

Salmonella poisoning is a form of gastroenteritis. It is the most common cause of outbreaks of foodborne disease in the United States. This bacteria may infect meat, dairy and vegetable products. Outbreaks are most common in warm weather and in children under the age of seven. Nausea, vomiting, and chills are the most common initial symptoms. These are followed by abdominal pain, diarrhea and fever which may last from five days to several weeks. The CDC estimates that there are approximately 2 to 4 million Salmonellosis cases in the United States each year.

Botulism is a form of gastroenteritis caused by a bacterial toxin. This toxin is a neuromuscular poison. It occurs in three forms: foodborne, wound, and infantile botulism. The most common form is foodborne. The patient may experience weakness, fatigue, headache, and dizziness as well as nausea, vomiting, diarrhea and abdominal pain. (For more information on this disorder, choose "Botulism" as your search term in the Rare Disease Database.)

Ptomaine Poisoning is the fourth most common cause of bacterial foodborne disease in the United States. It is caused by a protein enterotoxin that is produced after eating infected food, usually meat products. The disease is characterized by severe abdominal cramps and diarrhea. Nausea often occurs as well. However, vomiting and fever are rare.

Cholera is a bacterial infection involving the entire small intestine and marked by severe diarrhea and vomiting. Symptoms are caused by a toxin released by the Vibrio cholerae bacteria. Drinking water, or eating seafood, vegetables, and other foods contaminated with the excrement of Cholera patients spreads the disease. (For more information on this disorder, choose "Cholera" as your search term in the Rare Disease Database.)

Typhoid is treated with the antibiotic drugs chloramphenicol, ampicillin, cefoperazone, pefloxacin, co-trimoxazole or trimethoprim-sulfamethoxazole. Precautions to take, especially when visiting countries with unsanitary conditions, includes the practice of good personal hygiene and careful washing of hands. Avoid drinking untreated water, drinks served with ice, unpeeled fruits and vegetables, and other food that is cooked and not served hot. In food preparation; wash and sanitize utensils in hot water; carefully clean cutting boards, work areas and equipment; keep hot foods at 165 F and cold foods at 40 F or colder to avoid the possible growth of bacteria in food. Typhoid vaccination and food precautions are necessary before traveling to developing countries where this kind of disease is prevalent.

Scientists are investigating vaccines that will hopefully provide the traveler full protection against Typhoid without severe side-effects.

TEXT REFERENCE
Berkow R., ed. The Merck Manual-Home Edition. Whitehouse Station, NJ: Merck Research Laboratories; 1997:870-71.

Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:1068-70.




REVIEW ARTICLES
Engels EA, et al., Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2000;(2):CD001261.

Sirinavin S, et al., Antibiotics for treating salmonella gut infections. Cochrane Database Syst Rev. 2000;(2):CD001167.

Sood SK., Immunization for children traveling abroad. Pediatr Clin North Am. 2000;47:435-48, viii.

McCarron B., Diagnosing imported rashes and skin lesions. Practitioner. 1998;242:366-68, 371, 374 passim.

JOURNAL ARTICLES
Tacket CO, et al., Phase 2 clinical trial of attenuated Salmonella enterica serovar typhi oral live vector vaccine CVD 908-htrA in U. S. volunteers. Infect Immunol. 2000;68:1196-201.

Dilts DA, et al., Phase 1 clinical trials of aroA, aroD and aroA aroD htrA attenuated S. typhi vaccines; effect of formulation on safety and immunogenicity. Vaccine. 2000;18:1473-84.

Butler T, et al., Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India. J Antimicrob Chemother. 1999;44:243-50.

Chiu CH, et al., A clinical trial comparing oral azithromycin, cefixime and no antibiotics in the treatment of acute uncomplicated Salmonella enteritis in children. J Paediatr Child Health. 1999;35:372-74.

Girgis NI, et al., Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included patients with multidrug resistance. Antimicrob Agents Chemother. 1999;43:1441-44.

Cao XT, et al., A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Typhoid Study Group. Pediatr Infect Dis J. 1999;18:245-48.