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Typhoid Information for Healthcare Professionals

Clinical Features

Typhoid fever and paratyphoid fever are bacteremic illnesses that have an insidious onset characterized by fever, headache, constipation or diarrhea, malaise, chills, and myalgias, with few clinical features that reliably distinguish them from a variety of other infectious diseases. Diarrhea may occur, and vomiting is not usually severe. A transient, maculopapular rash of rose-colored spots may be present on the trunk. Confusion, delirium, and intestinal perforation may occur in severe cases, typically after 2-3 weeks of illness. The incubation period for typhoid fever is typically 6-30 days and for paratyphoid fever, 1-10 days.

Diagnosis

Blood culture is the mainstay of diagnosis. Bone marrow cultures have sensitivity of 80% in some studies and can remain positive despite antibiotic therapy. Stool and urine cultures are positive less frequently. Multiple cultures are usually needed to identify the pathogen. Serologic tests, such as the Widal test, are not recommended because of the high rate of false positives.

Etiologic Agent

Salmonella enterica serotype Typhi for typhoid fever and Salmonella enterica serotype Paratyphi for paratyphoid fever.

Incidence

An estimated 22 million cases of typhoid fever and 200,000 deaths occur worldwide each year. An estimated 5 million cases of paratyphoid fever occur worldwide each year.

Sequelae

Without therapy, the illness can last for 3-4 weeks and death rates range between 12% and 30%. Relapse occurs in up to 10% of untreated patients approximately 1-3 weeks after recovering from the initial illness and is often more mild than the initial illness. A chronic carrier state, in which stool or urine cultures for SalmonellaTyphi remain positive for more than 1 year, occurs in up to approximately 5% of infected persons.

Transmission

Typhoid fever and paratyphoid fever are transmitted commonly through the consumption of drinking water or food contaminated with the feces of people who have typhoid fever cases or are chronic carriers.

Challenges

Reduced susceptibility to fluoroquinolones (e.g., ciprofloxacin) and the emergence of multidrug resistance has complicated treatment of infections. There have also been sporadic reports and at least one documented outbreak of ceftriaxone-resistant Salmonella Typhi infections.

Opportunities

The role of new vaccines to control epidemics or to eliminate the disease has not been explored yet. These new vaccines include two typhoid fever protein conjugated vaccines licensed for use in India.

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