Typhoid fever
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Typhoid fever, also called enteric fever, is a sickness associated with unsanitary conditions. It has virtually disappeared in the United States since the early 1900’s, but can still be contracted in other countries where conditions are not as sanitary. Typhoid fever occurs when the Salmonella typhi bacteria is deposited in food or water by a human carrying the disease. An infected person can spread the infection to a water supply through the stool, which carries the bacteria in large concentrations. The water supply can then taint the food supply, as animals drink the water, and people use the water to prepare foods.


Typhoid fever is a very insidious disease. Some patients can remain carriers long after they have recovered from their illness; indeed, some cases are so mild that the patient doesn’t even know they’ve had typhoid fever, but they are still unwitting carriers of the disease to others. In addition, the bacteria can live for weeks outside of the body, so there is usually no way to tell where an outbreak came from or when it might have begun. A single carrier can unknowingly spread typhoid fever for years.


After the bacteria are eaten, they invade the small intestine and enter the bloodstream. From there, white blood cells carry them to the liver, spleen, and bone marrow. They stay there and multiply, then enter the bloodstream again in even greater numbers. This is the point when patients develop symptoms. From this re-entry into the bloodstream, the bacteria proceed to the gallbladder, the biliary system, and the lymphatic tissues in the bowels. They also invade the intestinal tract, from where some are expelled in the stool. A stool culture can detect the presence of the Salmonella typhi bacteria in the body.

Symptoms of typhoid fever include a high fever, sometime as high as one hundred three or one hundred four degrees, which is the result of the bacteria re-entering the bloodstream and being fought by the immune system. They also experience a loss of appetite, headaches, diarrhea (more common in children) or constipation (more common in adults), decreased urine output, achiness and lack of energy. In addition, stomach aches are common and some patients develop chest congestion. Occasionally, the patient will present a rash of rose-colored spot during the second week of infections.

More serious symptoms occur later in the disease’s development and include nosebleeds, chills, delirium and confusion, mood swings, inability to pay attention, and hallucinations. Some patients who are treated with antibiotics relapse after a week or two of feeling better. If this happens, they are treated again with different antibiotics.
typhoid fever
Image: Typhoid Fever


Typhoid fever is treated by giving the patient antibiotics specifically targeted against the Salmonella typhi bacteria. Before antibiotics were available, abut ten percent of people who got typhoid fever died of it, because of the overwhelming infection, or because of intestinal perforations or bleeding. Since the advent of antibiotics, however, survival rate is ninety-eight to ninety-nine percent. The patient may also be given fluids with electrolytes to replenish their hydration level. Typhoid fever is usually over in two to four weeks with treatment, but without treatment can cause some serious complications.


Complications from typhoid fever often reduce the patient’s chances of survival, since they can be very serious. A patient may experience severe gastrointestinal bleeding, which can happen at any place along the gastrointestinal tract as a result of the Salmonella typhi infection. A patient can also have perforations of the intestines, in which the bacteria create holes which keep the intestine from functioning properly. A patient may also experience kidney failure, and peritonitis, an inflammation of the tissue lining the walls of the abdomen.

The carrier state, in which the person may not suffer from the disease but is still spreading it, can be treated by a long-term course of antibiotics. For carriers, it may also be necessary to remove the gall bladder, which is a favorite place for the bacteria to hide and breed. If you are a carrier, you may not be allowed to return to your job after contracting typhoid fever until your doctor can certify that you are typhoid free. While you are being treated, you should be extra careful to wash your hands every time you go to the bathroom, and do not prepare or serve food to other people. This will lower the risk that you will pass the bacteria on to someone else.


Typhoid fever can be prevented. First, there is a vaccine available, so if you plan to travel to other countries with lower sanitation standards, this vaccine is advisable, though it’s important to know that it may not be a hundred percent affective against Salmonella typhi. Other preventative measures include frequent hand-washing, a practice not universally adopted in all places in the world. You should also be sure to thoroughly cook food, or that it is thoroughly cooked in the places where you eat. Boiling water before drinking or buying only bottles water or other drinks is important; don’t forget that this applies to ice, too, so ask for your drinks without ice unless you can be sure that the ice is made from bottled or boiled water. Always avoid areas where there might be open sewers or inadequate sanitation. If you think you may have contracted typhoid fever, see a doctor as soon as possible. As with most diseases, typhoid fever is easiest to treat if it is caught early, before the bacteria are too wide spread. It may be difficult to find a doctor if you are traveling in a foreign country, but the American consulate should be able to recommend some for you. If you have typhoid fever but do not seek treatment, you could continue to be ill for weeks or even months. Also, people who get their typhoid fever treated will probably not die; only one to two percent of people die even after being treated. However, twenty percent of those who delay treatment die, either from the infection or from complications.
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