| Disease/Syndrome |
Typhoid fever |
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| Category |
Infection, Occupational |
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| Acute/Chronic |
Acute-Severe |
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| Synonyms |
Enteric fever; Typhus abdominalis; Salmonella typhi infection |
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| Biomedical References |
Search PubMed |
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| Comments |
FINDINGS: In patients with light skin color, rose spots are seen in about 25% of cases. Intestinal hemorrhage occurs in about 1% of cases and relapses in about 10%-20%. [CCDM, p. 577-83] Other serotypes of Salmonella can cause enteric fever, but S. typhi causes the most severe disease. Initial symptoms are fever, myalgia, abdominal pain, headache, cough, and sore throat. Leukopenia and leukocytosis may occur, but the WBC count is usually normal. Diarrhea occurs in about 50% of cases. Constipation was common in the pre-antibiotic era. Hepatomegaly and splenomegaly may be present. Bradycardia and rose spots are usually absent according to more recent case series. Intestinal hemorrhage and perforation are the major complications seen in patients with disease lasting more than 2 weeks. [ID, p. 625-7] Rose spots are most commonly seen during the second week of illness. The spots are 2-3 mm in diameter, mainly on the trunk, blanch with pressure, and disappear in 3-5 days. [Current Consult, p. 992] Some patients have cervical lymphadenopathy. Less than 1% of patients have seizures and coma. [PPID, p. 2644-5] Possible complications include blood in stool, cholecystitis, intestinal perforation, pneumonia, osteomyelitis, endocarditis, meningitis, skin abscesses, glomerulitis, genitourinary tract infection, and shock. [Merck Manual, p. 1471] Stools positive for occult blood occurs in about 20-30% of cases, and less than 15% of patients have intestinal hemorrhage. About 3% of hospitalized patients suffer intestinal perforation. [Guerrant, p. 227-30] EPIDEMIOLOGY: Public sanitation programs have virtually eliminated this disease from many parts of the world. About 2% to 5% of untreated patients will become permanent carriers. Patients and carriers are sources of infection by contaminating food and water with feces or urine. The hands of carriers are usually the source of milk contamination, but cases of paratyphoid in England were traced back to dairy cows. Sewage-contaminated oysters and other shellfish are sources of infection. [CCDM] There are about 400 cases/year in the USA and an estimated 21 million cases and 200,000 deaths per year worldwide. [CDC] Flies may carry bacteria from feces to food. Spread by the fecal-oral route may occur among children playing and among adults through sexual contact. [Merck Manual, p. 1161] |
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| Latency/Incubation |
5 days to 3 weeks |
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| Diagnostic |
Culture of blood, urine, feces and bone marrow; |
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| ICD-9 Code |
002.0 |
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| Available Vaccine |
Yes |
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| Effective Antimicrobics |
Yes |
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| Scope |
"Risk is greatest for travelers to the Indian subcontinent and other low-income countries (in Asia, Africa, and Central and South America) who will have prolonged exposure to potentially contaminated food and drink." [CDC] |
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| Reference Link |
CDC - Typhoid Fever |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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| Job Tasks |
High risk job tasks associated with this disease:
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