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Typhoid fever

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This is about the disease typhoid fever. See typhus for an unrelated disease with a similar name. Paratyphoid fever is a related disease but is caused by a different bacteria.

Typhoid fever (or enteric fever) is an illness caused by the bacterium Salmonella Typhi. Common worldwide, it is transmitted by 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.

Contents

Symptoms

After infection, symptoms include:

Diagnosis

Diagnosis is made by blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.

Treatment

Typhoid fever can be fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, are commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. Usage of Ofloxacin along with Lactobacillus acidophilus is also recommended.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa and Latin America). Typhim Vi is an intramuscular killed-bacteria vaccination and Vivotif is an oral live bacteria vaccination, both of which protect against typhoid fever. Neither vaccine is 100% effective against typhoid fever and neither protects against unrelated typhus.

Transmission

While flying insects feeding on feces may occasionally transfer the bacteria to food being prepared for consumption, the disease is most commonly transmitted through poor hygiene habits and public sanitation conditions. Public education campaigns encouraging people to wash their hands after toileting and before handling food are an important component in controlling spread of the disease.

A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others. According to the Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover.

The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mary. In 1907 she became the first American carrier to be identified and traced. She was a cook in New York at the beginning of the 20th Century. Some believe she was the source of infection for several hundred people. She is closely associated with fifty cases and five deaths. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job, but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of a stroke after 23 years in quarantine.

Typhoid fever in history

Look Below for information.

Heterozygous advantage

It is thought that cystic fibrosis has risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. The lack of CFTR protein on the epithelium of the lungs prevents the bacteria's entry to the body. It is thought that cystic fibrosis only confers an advantage in cooler climates, so its levels are much lower in tropical climates where there is equal or greater levels of Typhoid fever. This is because CF sufferers are disadvantaged by their high level of salt loss in their sweat - a much more important aspect in warmer climates

Athens

In 430–426 B.C, a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. The balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides also contracted the disease, but survived to write about the plague. His writings are the primary source on this outbreak.

The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a study in 2006 by Manolis Papagrigorakis of the University of Athens detected DNA sequences similar to those of the bacterium responsible for typhoid fever. Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. In addition, as the disease is most commonly transmitted through poor hygiene habits and public sanitation conditions, it is an unlikely cause of a widespread plague, emerging in Africa and moving into the Greek city states, as reported by Thucydides.

Notable mortalities

External links

References

  • Gale's Encyclopedia of Medicine, published by Thomas Gale in 1999, ISBN 0787618683

 

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