Typhoid Fever Kirsten Mueller AP Biology Period 4/5
What is Typhoid Fever?
Typhoid Fever is a life-threatening illness caused by the bacterium Salmonella Typhi.
Typhoid Fever is also known as enteric fever, bilious fever or Yellow Jack.
It is a gram-negative short bacillus that is motile due its flagellum.
Gram-negative bacteria are pathogenic, meaning they can cause disease in a host organism.
About 400 cases of Typhoid Fever occur each year in the United States.
70% of these cases are acquired while traveling internationally.
Typhoid Fever affects approximately 12.5 million people each year.
According to the doctor-produced website of www.MedicineNet.com, patients with acute illness can contaminate the surrounding water supply through their feces which has a very high concentration of the bacteria.
After the acute, illness about 3%-5% of the people become carriers of the disease. Sometimes the illness goes unnoticed but these people become long-term carriers.
The bacteria will multiply while in the gallbladder, bile ducts and the liver and then pass into the bowel.
After ingested, the bacteria temporarily enter the blood stream and travel to the small intestine.
White blood cells carry the disease to the liver, spleen and bone marrow where it reproduces and reenters the blood stream.
The bacteria then invades the gallbladder, biliary system, and the lymphatic tissue of the bowel.
Typhoid Nodule in the liver
Abdominal Cavity including:
How is Typhoid Fever Contracted?
Typhoid Fever is contracted by the ingestion of the bacteria in contaminated food or water.
The bacteria itself only lives in humans and is carried through the blood stream and intestinal tract.
Both ill people and carriers of the disease spread the Typhoid bacteria through their feces.
Typhoid can be passed through animals, only through humans.
Flies however, are known to help transmit the disease because when they land on human excrement, it remains on their appendages and can be transmitted when they land on something else.
International History of Typhoid Fever
Around 430-426 B.C. it is believed that Typhoid Fever killed 1/3 of the population in Athens.
This was long disputed but after a DNA discovery in 2006, it was determined that it was the Typhoid Fever bacterium.
Between 2004-2005 an outbreak in the Dominican Republic occurred with 42,000 cases and 214 deaths.
National History of Typhoid Fever
In the late 19th century, a typhoid fever outbreak in Chicago occurred killing 65 per 100,000 people.
In 1891, the worst mortality rates were 174 per 100,000 people.
In 1907, the first American carrier was discovered - Mary Mallon aka Typhoid Mary.
According to statistics from the Centers for Disease Control have proved that the chlorination of drinking water has led to a decrease in the transmission of typhoid fever in the United States.
Where in the World?
Typhoid Fever is very common around the world except in industrialized nations such as the United States, Canada and Japan.
Fevers up to 103 ° or 104°
Generalized aches and pains
Occasionally a rash of flat, rose-colored spots
Typhoid Fever Rash
Constipation, then diarrhea
Stages of Typhoid Fever
Classically, the untreated typhoid fever is broken down into four different stages, each lasting about a week.
A slowly rising temperature
Relative bradycardia (unusually slow heart rate), malaise (discomfort or uneasiness), headache and cough.
In ¼ of cases, epistaxis (acute hemorrhage from the nostril, nasal cavity, or nasopharynx) can occur.
Stages of Typhoid Fever
Continuing high fever
Extremely distended abdomen
Considerable weight loss
Dicrotic pulse wave
Delirium is frequent, frequently calm and sometimes agitated.
Stages of Typhoid Fever
A number of complications can occur:
Intestinal hemorrhage due to bleeding
Encephalitis (inflammation of the brain)
Fever is still very high
Dehydration occurs and increases delirium
Lies motionless with eyes half-opened
Defervescence (very high fever) commences that continues into the fourth week.
Death occurred from the development of other complications such as:
Peritonitis (inflammation of the peritoneum, the thin membrane that lines the abdominal wall and covers most of the organs of the body)
Inflammation of the pancreas
Infections of the spine
Inflammation of the membranes surrounding the spinal cord and brain (meningitis)
Inflammation of the heart muscle
Diagnosis is made by blood, bone marrow, or stool.
The Widal test is commonly used to diagnose Typhoid.
Looks for salmonella antibodies against antigens O-somatic and H-flagellar)
Exams and Tests
An elevated white blood cell count
A blood culture the shows the bacteria
A stool culture
An ELISA test to show the Vi antigen
A platelet count (low platelet count)
A fluorescent antibody study
Fluorescent Antibody Test
The test checks for the antibody specific to the S. Typhi bacterium.
Enzyme-linked immunosorbent assay (ELISA)
The blood test looks for the antigen specific to the typhoid bacteria.
Carriers of Typhoid
3%-5% of people who have been infected become carriers of the disease.
Carriers are treated with prolonged antibiotics.
Removal of the gallbladder or the site of the infection will usually cure the patient.
Typhoid Carrier undergoes treatment
Carriers of Typhoid Fever
A carrier is usually a healthy person who survived the disease but in whom the bacteria are able to survive without causing further symptoms.
Carriers continue to spread the disease through their excrement without realizing it.
It is believed that Mary Mallon never actually had the disease however, her mother had typhoid while pregnant with her.
She infected 47 people and killed 3
She constantly changed her employment but the members of the household always got sick.
She was forced into containment for two years and then released under the conditions that she could no longer be a cook.
She assumed a false name and began cooking again and of course, infecting numerous people.
She was forced into life-time containment where she died 26 years later of pneumonia.
Famous People with Typhoid Fever
Abigail Adams, wife of President John Adams
Martha Bulloch, mother of Theodore Roosevelt
Stephan A. Douglas
William Wallace Lincoln, son of Abraham Lincoln
Archduke Karl Ludwig of Austria
More Famous People
Albert of Saxe-Coburg-Gotha, British prince consort, Queen Victoria’s husband
Henry Frederick, Prince of Wales, original heir ot the throne of James I of England
Mark Hanna, US politician
Those with cystic fibrosis are believed to have a natural resistance to Typhoid Fever.
The CFTR protein is present in both the lungs and the intestinal tract. The mutated protein in CF prevents entry of the typhoid bacteria into the body through these membrane.
Typhoid is treated with an antibiotic that kills the Salmonella bacteria.
With antibiotics, improvement can be seen in 1-2 days and recovery in 7-10 days.
Intravenous fluids and electrolytes may also be given to patients.
In most cases typhoid fever is not fatal.
Antibiotics such as ampicillin, chloramphenicol, trimethethoprim-sulfamethoxazole, and ciprofloxican.
These antibiotics have been used in most developed countries.
Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin are common drugs used against Typhoid but have now become resistant.
These drugs have not been used in over 20 years.
Typhoid that is resistant to multiple drugs is known as multidrug-resistant typhoid (MDR typhoid).
Chloramphenicol was the original prescribed drug to patients with Typhoid Fever.
However due to certain side effects, this drug has been replaced by others.
Choice of Drugs
The type of antibiotic prescribed is based on the region in which the disease originates.
Bacteria from certain areas in South America show a resistivity to many antibiotics.
Relapses of the disease are dealt with by the administration of antibiotics.
With the use of antibiotics, improvement can come usually in the fourth week.
The fever generally decreases back down to normal temperature in 7-10 days.
Signs and symptoms however, can return in up to 2 weeks after the fever has subsided.
Before the antibiotic, the death rate was 20%.
Antibiotics have reduced the fatality rate 1%-2%.
Antibiotic to prevent Typhoid Fever
How can Typhoid be avoided?
Avoid risky foods or drinks
Use only clean water
Ask for drinks without ice unless you know where it’s coming from
Only eat foods that have been thoroughly cooked
Avoid raw fruits and vegetables
Avoid food and drinks from street vendors
Vaccines are now available to those who are traveling abroad to underdeveloped countries.
Who should get the Typhoid Vaccine?
Travelers to parts of the world where Typhoid Fever is very common.
People who work with or come in contact with a carrier of the disease.
Laboratory analysts who work with the Salmonella Typhi bacteria.
The vaccine was discovered in 1897 by Almroth Edward Wright.
There are two types of vaccinations available:
Inactive (killed) vaccine in a shot (Vi capsular polysaccharide vaccine)
Live, attenuated (weakened) vaccine taken orally (Ty21a)
Administered at least 2 weeks before traveling.
Vaccination only lasts 2 years so booster shots are needed for those still at risk.
Not for children under 2 years of age.
Not for children under the age of 6.
4 administrations, each given 2 days apart.
Last administration should be given at least a week before traveling.
A booster shot is needed every 5 years.
Vaccinations 2 years 2 years 2 weeks N/A 1 Injection ViCPS (Typhim Vi, Pasteur Merieux) 5 years 6 years 2 weeks 2 days 4 1 capsule by mouth Ty21a (Vivotif Berna, Swiss Serum and Vaccine Institute) Booster needed every... Minimum age for vaccination Total time needed to set aside for vaccination Time between doses Number of doses necessary How given Vaccine Name
Risks of the Vaccination Shot
Fever (1 per 100 people)
Headache (3 per 100 people)
Redness or swelling at the site of injection (7 per 100 people)
Risks of Vaccination Oral
Fever (5 per 100 people)
Headache (5 per 100 people)
Abdominal discomfort, nausea, vomiting or rash are very rare
Reactions to Vaccination
Allergic reactions can be a result of the vaccination.
If a severe reaction occurs such as:
Increased heart rate
Call a doctor or seek medical treatment immediately