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Typhoid Fever
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What is Typhoid Fever?
Where is Typhoid Fever a problem?
Complications of Typhoid Fever
Who is at risk?
Prevention and treatment of Typhoid Fever

What is Typhoid Fever?

Typhoid fever is an acute infectious disease that is present (endemic) in many parts of the world, predominantly in countries where sanitation or standards of personal and food hygiene is poor, or where the water is unsafe to drink.  It is caused by the bacterium Salmonella typhi which belongs to the Salmonella group of bacteria.  There are approximately 2,000 different types of Salmonella, most of which cause gastroenteritis, or food poisoning.

Typhoid is spread via the faecal-oral route and this can be through food or drink that has been contaminated by the faeces of a typhoid patient or carrier of the bacteria.  Direct faecal-oral transmission can also occur.

The disease varies in severity from a mild illness to a severe life-threatening disease.  The incubation period depends on the quantity of the bacteria swallowed and can vary from 10 to 20 days.  Clinical symptoms include fever (which increases as the disease progresses), headache, diarrhoea, loss of appetite and nausea.

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Where is Typhoid Fever a problem?

Typhoid mainly affects low income regions of the world, where sanitation is poor and where there is a lack of clean water.  It is common in Africa, Asia, Central and South America and South East Europe.  Typhoid fever is rare in developed countries such as Ireland, but it may be imported by a traveller who has visited an endemic region or by contact with someone who has travelled.

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Complications of Typhoid Fever

Typhoid fever can have serious complications.  They occur in 10-15% of cases and are more common in untreated cases or in those who present late for treatment. They include intestinal bleeding and perforation, inflammation of the heart muscle, pneumonia, seizures, typhoid encephalopathy, and meningitis (usually in young children).  The case fatality rate is less than 1% with prompt antibiotic therapy but may be as high as 20% in untreated cases.

A longer term complication is that following the acute disease some patients may continue to excrete the organism in their faeces (stools).  Between 1-3% of cases become long-term carriers continuing to excrete the organism for more than one year after the initial illness. The likelihood of becoming a chronic carrier increases with age and is more common in women and those with biliary tract abnormality. These carriers usually have no symptoms and require prolonged courses of antibiotics to clear the organism.

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Who is at risk?

The risk of contracting typhoid fever is variable and depends on the country visited and is highest in India, Bangladesh and Pakistan.  The risk to a traveller when visiting high income countries is considered to be low.  Areas where typhoid is endemic can change and so it is important to check for the latest information before travelling.

Laboratory workers who handle specimens containing typhoid organisms may also be at risk.

In Ireland, typhoid fever usually occurs in travellers who have visited endemic areas.

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Prevention and treatment of Typhoid Fever

Typhoid fever can be successfully treated with antibiotic therapy; however drug-resistant strains have emerged.  A relapse of disease can occur in a small number of cases despite antibiotic treatment.  The symptoms are usually milder than the original illness and shorter in duration.

To help prevent the disease travellers should exercise scrupulous personal, food and water hygiene measures.  Vaccination is recommended for travellers to countries in Africa, Asia, Central and South America and South East Europe, and to other areas where hygiene is likely to be poor.

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References:
Royal College of Physicians of Ireland. National Immunisation Advisory Committee. Immunisation Guidelines for Ireland. 2008
Health Protection Surveillance Centre. Typhoid Fever Factsheet. July 2010.
National Travel Health Network and Centre (NaTHNaC). Typhoid and Paratyphoid Factsheet. September 2012.

 

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    Last Updated:    22/12/2014          SiteMap |