Salmonella Typhi (S. Typhi) - Common Worldwide, It Is Transmitted by The Fecal-Oral Route

INTRODUCTION
Typhoid fever is a potentially life-threatening illness that is caused by the bacteria

Salmonella typhi (S. typhi). Common worldwide, it is transmitted by the fecal-oral route
— the ingestion of food or water contaminated with feces from an infected person. The
bacteria then multiply in the blood stream of the infected person and are absorbed into the
digestive tract and eliminated with the waste. The organism is a Gram-negative short
bacillus that is motile due to its peritrichous flagella. The bacteria grow best at 37°C
(human body temperature).
The disease is characterized by a sustained fever as high as 40°C (104°F), profuse
sweating, gastroenteritis, and diarrhea. Less commonly a rash of flat, rose-colored spots
may appear.
Untreated typhoid fever lasts at least 4 weeks. Most of the classic signs and symptoms of
typhoid fever are prevented with prompt treatment. Clinical response begins about 2 days
after starting antibiotics, and the patient's condition markedly improves within 4-5 days.
The incubation period of typhoid fever varies with the size of the infecting dose and
averages 7-14 (range, 3-60) days. In paratyphoid infection, the incubation period ranges
from 1-10 days. During the incubation period, 10-20% of patients have transient diarrhea
(enterocolitis) that usually resolves before the onset of the full-fledged disease.
As bacteremia develops, the incubation period ends. Patients often experience chills,
diaphoresis, anorexia, dry cough, a dull frontal headache, and myalgias before the onset
of a high fever. About 20-40% of patients present with abdominal pain. In
immunocompetent adults, constipation is common and is most likely due to hypertrophy
of Peyer patches. Young children and individuals with AIDS are more likely to have
diarrhea that is probably due to blunted secondary immunity. The incidence of
constipation versus diarrhea varies geographically, perhaps because of local differences in
diet or S typhi strains or genetic variation.
Unusual modes of onset include isolated severe headaches that may mimic meningitis. S
typhi infection may cause an acute lobar pneumonia. In the early stages of the disease,
rigors are rare unless the person also has malaria. This is not an unusual pairing of
diseases. Patients may present with arthritis only, urinary symptoms, severe jaundice, or
fever.
What is typhoid fever?
Typhoid fever is a potentially life-threatening illness that is caused by the bacteria

Salmonella typhi (S. typhi). Persons with typhoid fever carry the bacteria in their
bloodstream and intestinal tract and can spread the infection directly to other people by
contaminating food or water.
Who gets typhoid fever?
Anyone can get typhoid fever if they drink water or eat food contaminated with the S.
typhi bacteria. Travelers visiting developing countries are at greatest risk for getting
typhoid fever. Typhoid fever is still common in the developing world, where it affects
about 12.5 million persons each year. Only about 400 cases occur each year in the United
States.
How does typhoid fever spread?
You can get typhoid fever by eating or drinking contaminated food or water. Food or
water can be contaminated by a food handler with S. typhi, or may be contaminated if
sewage accidentally gets into the food or water. Some infected persons may not show any
symptoms of typhoid fever but can shed the S. typhi bacteria in their feces for many
years. These persons are called typhoid fever "carriers". S. typhi is only found in humans.
What are the signs and symptoms of typhoid fever?
If you have typhoid fever you may have the following symptoms:
constant fever up to 104°
diarrhea
constipation
stomach pain
headache
malaise
nonproductive cough
slow heart rate (bradycardia)
anorexia
How soon after exposure do symptoms appear?
Symptoms usually occur within 1-2 weeks after exposure to the bacteria, but can occur
from 3 days - 3 months after exposure.
How is typhoid fever diagnosed?
Only your doctor can tell if you have typhoid fever. A blood or stool sample is needed to
diagnose typhoid fever. The samples are examined for S. typhi bacteria.
How is typhoid fever treated?
Typhoid fever is treated with antibiotics. A person will usually recover in 2-3 days with
prompt antibiotic treatment. People that do not get prompt medical treatment may
continue to have a fever for weeks or months, and as many as 20% may die from
complications of the infection.
If you are being treated for typhoid fever, it is important to do the following:
Take the prescribed antibiotics for as long as the doctor has asked you to take
them.
Wash your hands carefully with soap and water after using the bathroom
Do not prepare or serve food to other people.
Have your doctor collect follow-up stool samples to ensure that no S. typhi
bacteria remain in your body.
How can typhoid fever be prevented?
If you travel to an area where the disease is common, use the following steps to protect
yourself:
1. Get vaccinated against typhoid fever. Both injectable and oral vaccines are
available. Visit a doctor or travel clinic to discuss your vaccination options.
Vaccines are not 100% effective, so it is important to take the additional measures
listed to prevent typhoid fever.
2. Use careful selection of food and drink while you are in a developing country.
This will also help protect you from other illnesses such as cholera, dysentery and
hepatitis A.
3. Only use clean water. Buy it bottled or make sure it has been brought to a rolling
boil for at least one minute before you drink it. Bottled carbonated water is safer
than uncarbonated water.
4. Ask for drinks without ice unless the ice is made from bottled or boiled water.
5. Only eat foods that have been thoroughly cooked.
6. Avoid raw vegetables and fruits that cannot be peeled.
7. When you eat raw fruits or vegetables that can be peeled, wash your hands with
soap, then peel them yourself. Do not eat the peelings.
8. Avoid foods and beverages from street vendors. Many travelers get sick from food
bought from street vendors.
Remember:
1. Even if your symptoms go away without treatment, you may still be carrying the
S. typhi bacteria, and your illness could return and be passed to other people.
2. If you work at a job where you handle food or care for small children, you should
not go back to work until a doctor has determined that you no longer carry any
S.typhi bacteria.
3. Even if you are vaccinated, you should carefully select your food and drink,
especially when visiting areas where typhoid fever is common.

Salmonella Typhi (S. Typhi) - Common Worldwide, It Is Transmitted by The Fecal-Oral Route

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INTRODUCTION

Typhoid fever is a potentially life-threatening illness that is caused by the bacteria

Typhoid fever is a potentially life-threatening illness that is caused by the bacteria

Who gets typhoid fever?

How does typhoid fever spread?

What are the signs and symptoms of typhoid fever?

How soon after exposure do symptoms appear?

How is typhoid fever treated?

How can typhoid fever be prevented?

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