Typhoid Fever- Public Health

Typhoid Fever

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What is typhoid fever?Typhoid fever is a bacterial infection of the intestinal tract and

occasionally the bloodstream.

The disease rarely occurs in developed countries. It is most commonly seen in countries with poor sanitary conditions and contaminated water supplies.

Most of the cases are acquired during foreign travel to underdeveloped countries.

CAUSESIt is caused by infection with Salmonella typhi –

a bacteria found in infected animals and transmitted to persons in contaminated food or fluids. It is most often found in countries with poor sanitary conditions or contaminated water supplies. Boiling water and thoroughly cooking food can kill the microorganism. The infection can also be spread asymptomatic carriers. These are people who have the bacteria in their gastrointestinal tract, but do not have symptoms.

Who gets typhoid fever?

Anyone can get typhoid fever but the greatest risk exists to travelers visiting countries where the disease is common.

Occasionally, local cases can be traced to exposure to a person who is a chronic carrier.

Infants and persons over 60 usually have the severest cases.

TYPES:Systemic bacterial infection (Enteric Fever)

1.Salmonella typhi (Typhoid fever) Most common and more severe form

2. Salmonella paratyphi (Paratyphoid fever) Much more mild than Typhoid fever

TransmissionIngestion of contaminated food

Typhoid germs are passed in the feces and, to some extent, the urine of infected people.

The germs are spread by eating or drinking water or foods contaminated by feces from the infected individual.

Epidemiology: IncidenceWorld: 17 million cases per year U.S.: 400 cases per year (70% in travelers)PHILIPPINES (Nov 2006) 478 in Agusan del Sur. (May 2004) 292 in Bacolod City

Symptoms:Incubation (first 7-14 days after ingestion) Usually asymptomatic Diarrhea may occur Active infection Severe Headache Generalized Abdominal Pain Anorexia Constipation more common than Diarrhea Fever [usually higher in the evening]

Intermittent Fever initially Sustained Fever to high temperatures later

COMPLICATIONSSevere intestinal bleedingPerforation of the intestinePeritonitisPneumoniaCho cystitisUTITyphoid psychosisKidney failureRelapseDeath

Signs:Pulse-Temperature Dissociation (uncommon) Rose Spots (Pathognomonic, present in 25% of cases)

Blanching pink macular spots 2-3 mm over trunk

Complications: (occurs in 10-15% of cases)

Gastrointestinal Bleeding (2-10% of cases) Bowel perforation Typhoid encephalopathy

For how long can an infected person carry the typhoid germ?

The carrier stage varies from a number of days to years.

Only about 3% of cases go on to become lifelong carriers of the germ and

This tends to occur more often in adults than in children.

Laboratory ExamBlood Culture Best Test Sensitivity in first week Bone Marrow culture Higher sensitivity than Blood Culture Fecal culture Low sensitivity (~33%) Salmonella serology (Widal's Test) Poor Test Specificity Low Test Sensitivity (70%)

Should infected people be isolated?Because the germ is passed in the feces of infected people, only people with active diarrhea who are unable to control their bowel habits (infants, certain handicapped individuals) should be isolated.

Most infected people may return to work or school when they have recovered, provided that they carefully wash hands after toilet visits.

Children in daycare, health care workers, and persons in other sensitive settings must obtain the approval of the local or state health department before returning to their routine activities.

Food handlers may not return to work until three consecutive negative stool cultures are confirmed.

TREATMENTNon-pharmacologic

Drinking fluids- it helps prevent the dehydration that results from a prolonged fever and diarrhea.

Eating a healthy diet. Nonbulky high-calorie meals-can help replace

the nutrients you lose when you're sick.

TREATMENTPharmacologic

ORS(Oral Rehydration Salts)- Hydrite

Chloramphenicol – Drug of Choice-Chloro-V, Penachlor & Iclodex

Others : Amoxicillin, Cephalosphorins, Flouroquinolones

and Trimethoprim-Sulfamethoxazole

PreventionChoose foods processed for safety Prepare food carefully Foods prepared by others (avoid if possible) Keep food contact surfaces clean (3 wash cycle) Eat cooked food as soon as possible Maintain clean hands Steam or boil shellfish at least 10 minutes All milk and dairy products should be pasteurized Control fly populations

Vaccines Typhim Vi One vaccine

contains killed Salmonella typhi bacteria. This vaccine is administered through a shot.

Vivotif BernaThe vaccine contains

a live but weakened strain of the Salmonella bacteria that causes typhoid fever. 

This typhoid vaccine is taken by mouth.

Mary Mallon (September 23, 1869 – November 11, 1938)

Also known as Typhoid Mary

was the first person in the United States to be identified as a healthy carrier of typhoid fever.

She seemed a healthy woman when a health inspector knocked on her door in 1907, yet she was the cause of several typhoid outbreaks.

Since Mary was the first "healthy carrier" of typhoid fever in the United States, she did not understand how someone not sick could spread disease -- so she tried to fight back.

She was forcibly quarantined twice by public health authorities and died in quarantine.

Over the course of her career as a cook, she infected 47 people, three of whom died from the disease.

It was also possible that she was born with the disease, as her mother had typhoid fever during her pregnancy.