Typhoid Information

Typhoid is a bacterial disease transmitted through contaminated food and water. The risk of Typhoid is thought to be in the region of 1/3,000 to 1/5,000 for the International Traveller to the tropics – especially for those visiting parts of India. It is a very contagious disease and requires urgent treatment. Some patients remain carriers and may be capable of passing the disease to others.

Geographical distribution

The Gideon database (2000 http://www.cyinfo.com/) states that the estimated worldwide incidence of typhoid fever is 16 million (600,000 fatal) per year. In Africa 2,655,000 (130,000 fatal); Asia 13,310,000 (440,000 fatal); Latin America 595,000 (10,000 fatal), Oceania 7,500 (124 fatal). Attack rates in Africa and Asia exceed 500/100,000 per year.

Mode of Infection

The disease is transmitted through contaminated food and water. Insects may also play a role in transferring contaminated material to food for human consumption. The incubation period is usually between 10 to 14 days after infection.

Symptoms

Typically the disease presents with fever and severe headaches. Despite the high fever and the severity of the symptoms many patients will show the characteristic slowing of their heart rate. Patients may also have either constipation or diarrhoea. If diarrhoea is present it may show the characheristic green pea-soup appearance which is so common in both salmonella and shigella infections. The bacteria may escape from the intestinal into the blood stream and cause either a bacteraemia or a full septacaemia. Enlargement of the spleen, rose spots on the abdomen and a profound state of collapse may also be found. Some patients may perforate their intestinal wall if treatment is not commenced at an early time.

Diagnosis

Diagnosis relies on culturing the blood, urine or sputum to find the organism. Stool culture is often negative unless the disease remains untreated for some time. Bone marrow aspirate and culture may also be useful to confirm the presence of the bacteria.

Treatment

Various drugs are used to treat this condition. Most commonly nowadays Ciprofloxacin gives good rapid blood levels but it needs to be continued for between 10 days to 2 weeks. In developing countries Chloramphenicol is still widely used despite its potential to cause serious bone marrow toxicity. Growing resistance to Amoxicillin and various other drugs needs to be borne in mind when treating these patients.