Typhoid fever
Typhoid fever is an acute, systemic infectious disease primarily caused by the bacterium Salmonella enterica serotype Typhi, which is transmitted through contaminated food or water. The disease is characterized by symptoms such as fever, headache, abdominal pain, malaise, and a distinctive rash with rose-colored spots. Typically, the infection lasts about three weeks, and without treatment, it can lead to severe complications and a mortality rate of 10 to 20 percent.
Treatment commonly involves antibiotics, with ampicillin and ciprofloxacin being more frequently used than the earlier treatment option, chloramphenicol. While advances in sanitation have reduced its occurrence in developed countries, typhoid fever remains a significant public health issue globally, with over 9 million cases and more than 110,000 deaths reported annually as of 2019. Vaccines are available, but their effectiveness is limited, and individuals who recover from the disease can become healthy carriers, sometimes necessitating surgical removal of the gallbladder to eliminate the bacteria.
Preventive measures, particularly for travelers, include drinking boiled or bottled water and consuming well-cooked food. The historical case of "Typhoid Mary" illustrates the complexities surrounding carriers of the disease and has influenced public health policies and legal discussions regarding infectious disease management.
Typhoid fever
ANATOMY OR SYSTEM AFFECTED: Circulatory system, gallbladder, gastrointestinal system, intestines, kidneys, liver, skin, spleen
DEFINITION: An acute, systemic, febrile disease caused by bacteria that are transmitted through contaminated food or water
CAUSES: Bacteria transmitted through contaminated food or water
SYMPTOMS: Fever, headache, abdominal pain, malaise, rash with rose-colored spots
DURATION: Three weeks
TREATMENTS: Antibiotics
Causes and Symptoms
Typhoid fever, a serious disease with the potential to become epidemic under conditions of poor sanitation, is caused by the bacterium Salmonella enterica, serotype Typhi (formerly Salmonella typhi). These bacteria are transmitted to humans through the consumption of water or food contaminated with the feces from individuals who carry the serotype Typhi but who most often remain asymptomatic.
An infective dose of bacteria in susceptible individuals is estimated to be quite small, generally less than one thousand cells. The ingested bacteria pass through the stomach to the small intestines, where they establish an initial site of infection. These intestinal lesions usually ulcerate, and the bacteria spread to other body tissues via the bloodstream and lymphatic system. The organs most often affected by these secondary infections include the liver, spleen, kidneys, bone marrow, and especially the gallbladder. Symptoms include headache, abdominal pain, general malaise, and a generalized rash with rose-colored spots. If no complications ensue, then the fever will abate after about three weeks, but mortality rates average about 10 to 20 percent in untreated cases, according to the World Health Organization (WHO).
Treatment and Therapy
The first drug with demonstrable effectiveness in treating typhoid fever was chloramphenicol, which became generally available in 1948. Other antibiotics, notably ampicillin and ciprofloxacin, have largely replaced chloramphenicol as the treatment of choice, and their use has reduced the death rate to approximately 1 percent. Antibiotic resistance is a significant concern. Improved sanitation and living conditions since the 1920s have drastically reduced the incidence of this disease in the United States, although worldwide it remains a major public health concern. As of 2019, the latest year for which statistics were available, the World Health Organization estimates that at least 9 million cases and more than 110,000 deaths can be attributed to typhoid fever each year.
Vaccines are available to prevent typhoid fever, but their effectiveness is suboptimal. Temporary immunity is acquired by about 60 to 75 percent of vaccinated individuals. Individuals who recover from the disease often become healthy carriers of the bacteria, and surgical removal of the gallbladder may be necessary to rid them of their carrier status. Individuals can reduce the likelihood of contracting infection when traveling by drinking only boiled or bottled water, consuming only food that is thoroughly cooked, and washing one's hands well before eating.
Perspective and Prospects
The most famous case of a healthy carrier of the typhoid fever bacteria was a cook by the name of Mary Mallon, called “Typhoid Mary,” who worked in several establishments in New York during the period from 1902 to 1915. In those years, she was linked to several different outbreaks of typhoid fever, resulting in fifty-one cases of illness and three deaths. When she repeatedly refused to cooperate with public health authorities, she was eventually taken into custody and confined in a state hospital. After almost three years, she was released, but she soon skipped parole and disappeared. Four years later, she was apprehended again as the source of a typhoid fever outbreak that involved twenty-five cases and two deaths. She was returned to the secure hospital in 1915, where she remained until her death in 1938. The important legal issues generated by her case, including incarceration for having an infectious disease and forced surgery, were the driving forces behind the founding of the American Civil Liberties Union (ACLU).
Bibliography
Lock, Stephen, et al., editors. The Oxford Companion to Medicine. 3rd ed., Oxford UP, 2006.
Murray, Patrick R., et al. Medical Microbiology. 8th ed., Mosby/Elsevier, 2016.
Tortora, Gerard J., et al. Microbiology: An Introduction. 12th ed., Pearson, 2016.
"Typhoid." World Health Organization, 30 Mar. 2023, www.who.int/news-room/fact-sheets/detail/typhoid. Web. Accessed 8 Apr. 2024.
"Typhoid Fever." Centers for Disease Control and Prevention, 18 July 2016, www.cdc.gov/typhoid-fever/. Accessed 8 Apr. 2024.
"Typhoid Fever." MedlinePlus, National Library of Medicine, 20 June 2021, medlineplus.gov/ency/article/001332.htm. Web. Accessed 8 Apr. 2024.