Gastroenterology Book

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Typhoid Fever

Aka: Typhoid Fever, Enteric Fever, Salmonella typhi, Paratyphoid Fever, Salmonella partyphi, Rose Spot
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  1. See Also
    1. Salmonellosis
    2. Foodborne Illness
    3. Waterborne Illness
    4. Fever in the Returning Traveler
  2. History
    1. Typhoid Mary was a cook who infected 51 patients
      1. Brooks (1996) CMAJ 154:915-6
  3. Epidemiology: Incidence
    1. World: 17 million cases per year
    2. U.S.: 400 cases per year (70% in travelers)
  4. Pathophysiology
    1. Systemic bacterial infection (Enteric Fever)
      1. Salmonella typhi (Typhoid Fever)
        1. Most common and more severe form
      2. Salmonella paratyphi (Paratyphoid Fever)
        1. Much more mild than Typhoid Fever
    2. Transmission
      1. Ingestion of contaminated food (via feces or urine)
  5. Risk factors
    1. Travel to developing country or refugee camp
    2. Highly dense living conditions
  6. Symptoms
    1. Incubation (first 7-14 days after ingestion)
      1. Usually asymptomatic
      2. Diarrhea may occur
    2. Active infection
      1. Severe Headache
      2. Generalized Abdominal Pain
      3. Anorexia
      4. Constipation more common than Diarrhea
      5. Fever
        1. Intermittent Fever initially
        2. Sustained Fever to high temperatures later
  7. Signs
    1. Relative Bradycardia
    2. Pulse-Temperature Dissociation (uncommon)
    3. Rose Spots (Pathognomonic, present in 25% of cases)
      1. Blanching pink macular spots 2-3 mm over trunk
  8. Labs
    1. Blood Culture
      1. Best Test Sensitivity in first week
    2. Bone Marrow culture
      1. Higher sensitivity than Blood Culture
    3. Fecal culture
      1. Low sensitivity (~33%)
    4. Salmonella serology (Widal's Test)
      1. Poor Test Specificity
      2. Low Test Sensitivity (70%)
  9. Differential Diagnosis
    1. Mononucleosis
    2. Brucellosis
    3. Tularemia
    4. Influenza
    5. Psittacosis
  10. Management: Antibiotics
    1. Antibiotic Resistance is increasing
    2. First-Line: Fluoroquinolones
    3. Alternative antibiotics (resistance is common)
      1. Chloramphenicol
      2. Amoxicillin
      3. Trimethoprim-Sulfamethoxazole (Septra)
  11. Complications (occurs in 10-15% of cases)
    1. Gastrointestinal Bleeding (2-10% of cases)
    2. Bowel perforation
    3. Typhoid encephalopathy
  12. Prevention
    1. See Foodborne Illness Prevention
    2. See Water Disinfection
    3. Steam or boil shellfish at least 10 minutes
    4. All milk and dairy products should be pasteurized
    5. Control fly populations
  13. References
    1. Butler in Goldman (2000) Cecil Medicine, p. 1681-3
    2. Pearson in Mandell (2000) Infectious Disease, p. 1136
    3. Maskalyk (2003) CMAJ 169:132

Salmonella typhi (C0036125)

Definition (CSP) serotype of the species, Salmonella enterica, and is the etiologic agent of typhoid fever.
Definition (MSH) A serotype of SALMONELLA ENTERICA which is the etiologic agent of TYPHOID FEVER.
Concepts Bacterium (T007)
MSH D012485
SnomedCT 5595000
English Bacillus typhosus, Salmonella typhosa, Salmonella 9,12,Vi;d;-, S. typhi, s typhi, s. typhi, salmonella typhi, typhi salmonella, salmonella typhi organism, salmonella typhy, typhoid bacillus, salmonella typhosa, Salmonella enterica serovar Typhi, Eberthella typhi, Typhoid bacillus, Salmonella typhi, Salmonella typhi (organism), Salmonella 9,12, [Vi]:d:-, Salmonella 9,12,Vi:d:-, Salmonella Typhi (organism), Salmonella Typhi, Salmonella enterica subsp. enterica ser. Typhi
French Salmonella enterica sérotype Typhi, Salmonella typhosa, Salmonella enterica serovar Typhi, Salmonella typhi
Swedish Salmonella typhi
Spanish Salmonella typhi (organismo), Salmonella 9,12, [Vi]:d:-, Salmonella typhosa, Salmonella typhi, Salmonella 9,12,Vi:d:-, Eberthella typhi, Salmonella Typhi, bacilo tifoideo, Salmonella Typhi (organismo), Salmonella enterica subesp. enterica ser. Typhi
Czech Salmonella typhi
Finnish Salmonella typhi
Russian BRIUSHNOTIFOZNAIA PALOCHKA, BRIUSHNOI TIF, VOZBUDITEL', БРЮШНОЙ ТИФ, ВОЗБУДИТЕЛЬ, БРЮШНОТИФОЗНАЯ ПАЛОЧКА
Japanese サルモネラ･ティフィ, チフス菌, サルモネラチフィ, 腸チフス菌
Italian Salmonella typhosa, Salmonella enterica serovar Typhi, Salmonella typhi
Croatian SALMONELLA TYPHI
Polish Pałeczki duru brzusznego, Salmonella typhi
German Salmonella typhi, Salmonella typhosa
Dutch Salmonella typhi
Portuguese Salmonella typhi
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Typhoid Fever (C0041466)

Definition (CSP) acute systemic febrile infection caused by Salmonella typhi.
Definition (MSH) An acute systemic febrile infection caused by SALMONELLA TYPHI, a serotype of SALMONELLA ENTERICA.
Concepts Disease or Syndrome (T047)
MSH D014435
ICD9 002.0
ICD10 A01.0, A01.00
SnomedCT 186091002, 4834000, 154270009, 266174006
English Abdominal Typhus, Enteric Fever, Enteric Fevers, Fevers, Enteric, Typhoid, Typhoids, Typhus, Abdominal, FEVER, ENTERIC, Fever, Enteric, TYPHOID FEVER, TYPHUS ABDOMINALIS, Enteric fever, typhoid fever (diagnosis), typhoid fever, Fever: [typhoid] or [enteric] (disorder), Salmonella typhi infection, Typhoid fever, unspecified, Typhoid Fever [Disease/Finding], enteric fever, Typhoid Fevers, Fever, Typhoid, Fevers, Typhoid, Typhoid fever, Infection by Salmonella typhi, Typhoid fever (disorder), typhoid, Salmonella; infection, typhi, Salmonella; typhoid fever, ileotyphus, infection; Salmonella, typhi, infection; typhoid, typhoid; infection, Fever: [typhoid] or [enteric], Typhoid fever any site, Typhoid infection any site, Typhoid any site, Typhoid infection, Typhoid Fever
Dutch tyfoïde, Salmonella typhi-infectie, enterische koorts, Salmonella; infectie, typhi, Salmonella; typhus abdominalis, infectie; Salmonella, typhi, infectie; tyfus, tyfus; infectie, buiktyfus, Buiktyfus, Tyfus, Typhus abdominalis
German enterisches Fieber, Bauchtyphus, Salmonella typhi-Infektion, Typhusfieber, Febris thyphoides, Typhus abdominalis, Typhus
Italian Tifoide, Infezione da Salmonella typhi, Tifo addominale, Febbre enterica, Febbre tifoide
Portuguese Infecção por Salmonella typhi, Tifóide, Febre entérica, Febre tifóide, Febre Entérica, Febre Tifóide, Tifo Abdominal
Spanish Tifoideas, Infección por Salmonella typhi, Fiebre entérica, Fever: [typhoid] or [enteric], Typhoid fever, Typhoid, Enteric fever, fiebre entérica, fiebre tifoidea (trastorno), fiebre tifoidea, infección por Salmonella typhi, tifoide, Fiebre tifoidea, Fiebre Entérica, Fiebre Tifoidea, Tifus Abdominal, Fiebre Enterica
Japanese 腸チフス熱, チフス菌感染, ﾁｮｳﾁﾌｽ, ﾁｮｳﾁﾌｽﾈﾂ, ﾁﾌｽｷﾝｶﾝｾﾝ, ﾁｮｳﾈﾂ, 腸チフス, 腸熱
Swedish Tyfoidfeber
Czech tyfus břišní, Břišní tyfus, Infekce Salmonella typhi
Finnish Lavantauti
Russian TIFOIDNAIA LIKHORADKA, BRIUSHNOI TIF, БРЮШНОЙ ТИФ, ТИФОИДНАЯ ЛИХОРАДКА
Korean 장티푸스
Croatian TIFUSNA GROZNICA, TRBUŠNA
Polish Gorączka durowa, Dur brzuszny, Gorączka brzuszna
Hungarian Typhoid, Enteralis láz, hastífusz, Salmonella typhi fertőzés
French Fièvre typhoïde, Typhoïde, Typhus abdominal, Fièvre entérique, Infection à Salmonella typhi
Sources
Derived from the NIH UMLS (Unified Medical Language System)


ROSE SPOT (C0240915)

Concepts Finding (T033)
English ROSE SPOT, rose spot, rose spots
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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