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Ô
  
 

* 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.
þ utbreaks are rare.

þ The germ that causes typhoid is a unique

human strain of Salmonella called Salmonella
typhi.
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þ It is caused by infection with K




 D
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.
?  
 




þ
fter the ingestion of contaminated food or water,
the Salmonella bacteria invade the small intestine
and enter the bloodstream temporarily. The
bacteria are carried by white blood cells in the liver,
spleen, and bone marrow. The bacteria then
multiply in the cells of these organs and reenter the
bloodstream. Patients develop symptoms, including
fever, when the organism reenters the bloodstream.
Bacteria invade the gallbladder, biliary system, and
the lymphatic tissue of the bowel. Here, they
multiply in high numbers. The bacteria pass into the
intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory.
Ô   
 

þ
nyone can get typhoid

þ ccasionally, local cases can be traced to
exposure to a person who is a chronic carrier.
þ Infants and persons over 60 usually have the
severest cases.
|

þ Ingestion of contaminated food

þ Typhoid germs are passed in the feces and, to

some extent, the urine of infected people.

þ The germs are spread by eating or drinking

water or foods contaminated by feces from
the infected individual.
à  
þ orld: 17 million cases per year
þ .S.: 400 cases per year (70% in travelers) ²
while only karachi may have 400 cases every
few months.
þ


 
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þ The symptoms may occur rapidly, particularly
in children.

þ However, in adults, they usually come on

slowly

þ elapses are common.

þ Symptoms generally appear one to three

weeks after exposure.
K
þ Incubation (first 7-14 days after ingestion)
þ sually asymptomatic
þ iarrhea may occur
þ
ctive infection
þ Severe Headache
þ eneralized
bdominal Pain
þ
norexia
þ onstipation more common than iarrhea
þ ever [usually higher in the evening] 103 -
104  (39 -40 ).
þ Intermittent ever initially
þ Sustained ever to high temperatures later
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þ The carrier stage varies from a number of
days to years.
þ nly about 3% of cases go on to become
lifelong carriers of the germ and
þ This tends to occur more often in adults than
in children.
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þ
vaccine is available
þ but is generally reserved for people traveling
to underdeveloped countries where
significant exposure may occur.
þ Types of vaccines include:
þ |
 is a live attenuated bacterial vaccine
that protects against typhoid.It is one of two
typhoid vaccines currently recommended by
the orld Health rganization.The vaccine
offers between 33 and 78% protection.
þ The vaccine is given by mouth. The vaccine is
presented either as capsules or a liquid
suspension.
þ | 
 
   
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þ The vaccine is only 60 to 80% protective and

the traveller should still be warned to take all
usual precautions (careful hygiene, hand
washing and food preparation).
þ The vaccine is injected either under the skin or
into a muscle at least seven days before
traveling to the typhoid-affected area
(recommend 14 days). The vaccine is not
effective in children under the age of two.
þ To maintain immunity, the vaccine should be
repeated every three years.


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þ hoose foods processed for safety
þ Prepare food carefully
þ oods prepared by unhygienic hotels (avoid if
possible)
þ eep food contact surfaces clean
þ
at cooked food as soon as possible
þ aintain clean hands
þ
ll milk and dairy products should be
pasteurized
þ ontrol fly populations
þ
void raw vegetables and fruits that cannot be
peeled. Vegetables like lettuce are easily
contaminated and are very hard to wash well.
þ
void foods and beverages from street vendors. It is
difficult for food to be kept clean on the street, and
many travelers get sick from food bought from
street vendors.
þ et vaccinated against typhoid fever.
ß

(K

 
Virulence actors: S. typhi has a combination
of characteristics that make it an effective
pathogen. This species contains an endotoxin
typical of ram negative organisms, as well
as the Vi antigen which is thought to increase
virulence. It also produces and excretes a
protein known as ´invasinµ that allows non-
phagocytic cells to take up the bacterium,
where it is able to live intracellularly. It is also
able to inhibit the oxidative burst of
leukocytes, making innate immune response
ineffective.
„
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can be very dangerous if not taken care of properly.
Not only live in the bloodstream or intestinal tract of
humans,but is also found in sewage.

ven though most people either die or use antibiotics to

stop the growth of these bacteria, a very small
percentage of the people who get typhoid fever have
certain antibodies that are able to restrict the growth of
salmonella typhi and therefore are able to live.

These people plus the people that are cured through

antibiotics are called carriers because even though they
will have no more symptoms of typhoid fever, they will
still have the bacteria inside of them.