Typhoid fever overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Typhoid fever, also known as enteric fever and Salmonella typhi infection,[1] is an illness caused by the bacterium Salmonella enterica serovar typhi. Common worldwide, it is transmitted by the fecal-oral route — the ingestion of food or water contaminated with feces from an infected person.[2] The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.

Historical perspective

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. A 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever.[3] Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.[4]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.In 1897, Almroth Edward Wright developed an effective vaccine. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality.

Classification

There is no established classification system for typhoid fever. However, typhoid fever may be classified based on duration of illness, serologic type causing disease, severity of illness and virulence factors.[5]

Pathophysiology

The sequence of events in the pathogenesis of typhoid fever include innoculation, gastrointestinal infection, systemic involvement and chronic carrier state.[5][6][7][8][9][10][11][12][13][14][15]

Causes

Typhoid fever is caused by Salmonella enterica serotype Typhi (Salmonella Typhi)[16][17][18][19][20][21]. Salmonella Typhi is a gram negative bacillus, belongs to Enterobacteriaceae family, is flagellated, facultatively anaerobic and contain three important antigens O,H and Vi.[22]

Differentiating typhoid fever from other diseases

Typhoid fever must be differentiated from other diseases that cause fever, diarrhea, and dehydration, such as Ebola, Shigellosis, Malaria, Lassa fever, Brucellosis,Viral hepatitis, leptospirosis, rheumatic fever, typhus, appendicitis, dengue fever,toxoplasmosis, rickettsial diseases, leishmaniasis, tuberculosis and mononucleosis, Abdominal abcess, Yellow fever[23][24][5][25][26]

Epidemiology and Demographics

With an estimated 16-33 million cases of typhoid annually resulting in 500,000 to 600,000 deaths. In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths[27][28]. Worldwide, typhoid fever is most prevalent in areas that are overcrowded with poor hygiene and sanitation. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year. 1-6% of the individuals who are infected will develop a chronic infection in the gall bladder[29][30]. Worldwide, the incidence of typhoid fever varies in different parts of world[31][26][32]. Age, race, gender and certain environmental factors affect the distribution of disease among these groups[33][34][35].

Risk factors

Common risk factors in the development of typhoid fever are travel to endemic areas, poor hygiene habits, poor sanitation conditions, flying insects feeding on feces, contact with person recently suffered typhoid fever, recent use of antibiotics, achlorhydria, immunosuppressive illnesses such as AIDS, crowded housing, usage of raw fruits and vegetables contaminated with sewage, prolonged illness, health care workers exposed to typhoid infection, clinical microbiologists handling salmonella typhi, childhood period. [36][37][38][39][40][41]. Presence of C282 mutation and CFTR polymorphism may confer protection against typhoid fever. [42][43][44]

Screening

Natural history and complications

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

References

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  21. http://www.cdc.gov/typhoid-fever/health-professional.html
  22. Fàbrega, Anna, and Jordi Vila. "Salmonella enterica serovar Typhimurium skills to succeed in the host: virulence and regulation." Clinical microbiology reviews 26.2 (2013): 308-341.
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