Typhoid fever
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| ICD-10 | A01.0 |
|---|---|
| ICD-9 | 002 |
Typhoid fever is an illness caused by the bacterium Salmonella Typhi. Common worldwide, it is transmitted by ingestion of food or water contaminated with feces from an infected person.[1] The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.
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[edit] Symptoms
People with typhoid fever typically have a sustained fever as high as 103° to 104° F (39° to 40° C). They may also feel weak, or have gastroenteritis, headache, diarrhea and anorexia (loss of appetite). In some cases, patients have a rash of flat, pee-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi.[2]
Classically, untreated typhoid fever course is divided in 4 weeks. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough . Epistaxis is seen in a quarter of cases and abdomianl pain is also possible. There is leukopenia 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 prostrated with high fever in plateau around 40ºC and bradycardia ( Sphygmo-thermic dissociation), classicaly with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated and this delirium gave to typhoid the nickname of "nervous fever". Rose spots appear in lower chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be felt. Diarrhea can occur in this stage : six to eight stools in a day , green with a characteristic smell, comparable to pea-soup. Howewer, constipation is also frequent. The spleen and liver are enlarged and tender and there is elevation of transaminases . The widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive in this stage. In the third week of the typhoid fever a number of complications can occur:
- Intestinal haemorrhage due to bleeding in the congested Peyer patches, that can be very serious but generally does not led to death
- Intestinal perforation in distal ileon : this is a very serious complication that is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
- Toxic myocarditis with collapse
- Encephalitis
- Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little around the day . Dehydration ensues and the patient is delirious ( typhoid state). By the end of third week defervescence commemnces that prolongs itself in the fourth week
[edit] Diagnosis
Diagnosis is made by 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 with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures. [2]
[edit] Treatment
Typhoid fever can be fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.
When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa and Latin America). Typhim Vi is an intramuscular killed-bacteria vaccination and Vivotif is an oral live bacteria vaccination, both of which protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither protects against unrelated typhus.
[edit] Resistance
Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).
Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone.
There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method.[3] It not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent disc testing and cannot test for MICs.
[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 toileting and before handling food are an important component in controlling spread of the disease. According to statistics from the United States Center for Disease Control, 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 Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover.
[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. 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] History
Around 430 - 426 B.C., a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. The balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak. The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever.[4] Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.[5] The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of Attica was besieged within the Long Walls and lived in tents.
In the late 19th century, typhoid fever mortality rate in Chicago averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 persons.[6] The most notorious carrier of typhoid fever—but by no means the most destructive—was Mary Mallon, also known as Typhoid Mary. In 1907, she became the first American carrier to be identified and traced. She was a cook in New York; some believe she was the source of infection for several hundred people. She is closely associated with forty seven cases and three deaths.[7] Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.
In 1897, Almroth Edward Wright developed an effective vaccine.
Most developed countries saw declining rates of typhoid fever throughout 1st half of 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. At the present time, incidence of typhoid fever in developed countries is around 0.5 cases per 100,000 people per year.
[edit] Famous typhoid victims
Famous people who have succumbed to the disease include:
- Alexander the Great (Typhoid is one of many possibilities of his cause of death, including malaria, West Nile virus, pancreatitis, and poisoning.)
- Pericles
- Archduke Karl Ludwig of Austria
- Franz Schubert (disputed)
- Charles Trenet
- Margaret Breckenridge, highest-ranking Army nurse under Ulysses S. Grant
- Evangelista Torricelli
- Benjamin Harrison's wife Caroline
- Robert E. Lee's daughter Annie
- Mary Henrietta Kingsley
- Herbert Hoover's father and mother
- Mark Hanna
- William McKinley's daughter Katherine
- Wilbur Wright
- Leland Stanford, Jr.
- William T. Sherman's father and oldest son (Willie).
- Albert of Saxe-Coburg-Gotha, British prince consort, Queen Victoria's husband
- Ann Rutledge, alleged fiancée of Abraham Lincoln
- William Wallace Lincoln, third son of President Abraham Lincoln and Mary Todd Lincoln
- Stephen A. Douglas
- Louis Pasteur's daughters Cecile and Jeanne
- President John Adams's wife Abigail Adams
- K.B. Hedgewar, founder of Rashtriya Swayamsewak Sangh
- General Stonewall Jackson's mother, father and daughter
- John Buford
- Charles Darwin's daughter Annie
- Joseph Lucas
- Ignacio Zaragoza
- Alexander Alexandrovich Friedman
- Henry Frederick Stuart, Prince of Wales, original heir to the throne of James I of England
- Thomas Baker, Iowa Militia Colonel, California State Senator, and founder of Bakersfield, Kern County, California.
[edit] Food
- Juices should be taken, especially orange juice.
- Light soups can be taken
- Eggs and non-veg foods should be avoided
- High fiber diet should be avoided in starting days
- Lot of rest should be taken
[edit] References
- ^ Giannella RA (1996). Salmonella. In: Baron's Medical Microbiology (Baron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN.
- ^ a b Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill. ISBN.
- ^ Cooke FJ, Wain J, Threlfall EJ (2006). "Fluoroquinolone resistance in Salmonella Typhi (letter)". Brit Med J 333 (7563): 353–4.
- ^ Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E (2006). "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens". Int J Infect Dis 10 (3): 206-14. PMID 16412683}.
- ^ Shapiro B, Rambaut A, Gilbert M (2006). "No proof that typhoid caused the Plague of Athens (a reply to Papagrigorakis et al.)". Int J Infect Dis 10 (4): 334-5; author reply 335-6. PMID 16730469.
- ^ 1900 Flow of Chicago River Reversed. Chicago Timeline. Chicago Public Library. Retrieved on February 8, 2007.
- ^ Nova: The Most Dangerous Woman in America.
[edit] Further reading
- Gale's Encyclopedia of Medicine, published by Thomas Gale in 1999, ISBN
[edit] External links
- www.netdoctor.co.uk. Article on typhoid fever for travelers. Retrieved on December 17, 2007.
- United States Center for Disease Control and Prevention Listing
- Harrison, Noel G. (2007). www.healthsystem.virginia.edu. Historical exhibit on efforts by US Army to control typhoid fever. Retrieved on Error: invalid time.jahangeer
- www.medicalnewstoday.com. Article on typhoid fever and the fall of Athens. Retrieved on February 17, 2007.
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