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(Enteric Fever · Typhoid Fever)

In this condition factsheet:

The Facts on Typhoid

Typhoid, also known as typhoid fever or enteric fever, is an infection caused by the bacteria Salmonella typhi.

Across the world, millions of people are infected annually by typhoid, and about 200,000 of them die. The number of people infected with typhoid each year is very low in North America and the industrialized world, but typhoid is common in developing countries.

Typhoid is usually curable, but some bacterial strains are becoming increasingly resistant to antibiotics. Most people with typhoid in North America acquire it while travelling to developing areas of the world.

If untreated, about 10% to 16% of people with typhoid will die. This drops to less than 1% when people are treated promptly.

Causes of Typhoid

Typhoid is usually transmitted by water or food, in much the same way as cholera. People who are infected excrete live bacteria in their feces and urine. They are usually contagious for a few days before any symptoms develop, so they don't know they need to take extra precautions. If they don't wash their hands properly, the typhoid bacillus can be transferred to food or water and from there to another person. Also, it can be spread directly from person to person via contaminated fingers.

About 3% of infected people (treated or not) become asymptomatic carriers of Salmonella typhi. This means that they continue to shed bacteria in their feces for at least a year and often for life but don't have any symptoms of typhoid. There are a small number of typhoid carriers in every country. Even Canada and the United States report dozens of locally transmitted cases of typhoid each year, though most cases in these countries are among travellers or people immigrating who are ill when they arrive.

Symptoms and Complications of Typhoid

Symptoms usually appear 1 or 2 weeks after infection but may take as long as 3 weeks to appear. Typhoid usually causes a high, sustained fever, often as high as 40°C (104°F), and extreme exhaustion.

Other common symptoms include:

  • constipation
  • cough
  • headache
  • loss of appetite
  • stomach pains
  • sore throat

Rarer symptoms include:

  • bleeding from the rectum
  • delirium
  • diarrhea
  • temporary pink spots on the chest and abdomen

With antibiotic treatment, symptoms start to subside after 5 to 7 days, but without treatment they continue to get worse for several weeks, and more than 10% of untreated people may die.

A small number of people who recover from typhoid may have a relapse of their symptoms just a few weeks later. The second bout tends to be less severe than the first, and clears up quickly with further treatment.

Many people suffer from mild intestinal bleeding, but it is severe in only a small minority of cases. The main way typhoid kills is by causing perforation of the small intestines, causing bacteria to pour into the abdominal cavity. This condition is called peritonitis, and is often fatal.

Other complications of typhoid occur when a large number of bacteria get into the bloodstream, causing bacteremia. They can travel to the lungs, causing pneumonia, or to the lining of the brain (meningitis), the bones (osteomyelitis), the heart valves (endocarditis), the kidneys (glomerulonephritis), the genital or urinary tract, or the muscles. Hepatitis (inflammation of the liver) can also occur.



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