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Typhoid fever in Wikipedia

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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Typhoid fever". (Source - Retrieved 2006-09-07 14:08:06 from


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.$[1]$ The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.


After infection, symptoms include:


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.$[2]$


Typhoid fever can be fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, have been 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.


Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone.

There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method.$[3]$ It not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent on disc testing and cannot test for MICs.


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.

Heterozygous advantage

It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. The CFTR protein is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.


  • 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.$[4]$ 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.
  • 1860-1900 Chicago typhoid fever mortality rate averaged 65 per 100,000 population a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 persons.[1]

Origin and Spread

Famous typhoid victims

Other famous people who have succumbed to the disease include:

  • Alexander the Great
  • Pericles
  • Archduke Karl Ludwig of Austria
  • William the Conqueror
  • Franz Schubert
  • Margaret Breckenridge, highest-ranking Army nurse under Ulysses S. Grant
  • Evangelista Torricelli
  • Benjamin Harrison's wife Caroline
  • Robert E. Lee's daughter Annie
  • Mary Henrietta Kingsley
  • William Shakespeare
  • Herbert Hoover's father and mother
  • Mark Hanna
  • William McKinley's daughter Katherine
  • Wilbur Wright
  • Will Rogers' mother
  • Leland Stanford, Jr.
  • William T. Sherman's father
  • Albert of Saxe-Coburg-Gotha, British prince consort, Queen Victoria's husband
  • Ann Rutledge, alleged fiancée of Abraham Lincoln
  • William Wallace Lincoln, son of Abraham Lincoln
  • Tad Lincoln, son of Abraham Lincoln
  • Stephen A. Douglas
  • Louis Pasteur's daughters Cecile and Jeanne
  • John Adams's wife Abigail Adams
  • K.B. Hedgewar, founder of Rashtriya Swayamsewak Sangh
  • Stonewall Jackson's mother, father, and daughter
  • John Buford
  • Charles Darwin's daughter Annie
  • Joseph Lucas
  • Ignacio Zaragoza


  1. Giannella RA (1996). Salmonella. In: Baron's Medical Microbiology (Baron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
  2. Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill. ISBN 0-8385-8529-9.
  3. Cooke FJ, Wain J, Threlfall EJ (2006). "Fluoroquinolone resistance in Salmonella Typhi (letter)". Brit Med J 333 (7563): 353–4.
  4. Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E (2006). "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens". Int J Infect Dis 10 (3): 206-14. PubMed.
  • Gale's Encyclopedia of Medicine, published by Thomas Gale in 1999, ISBN 0-7876-1868-3

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