Gastroenterology Book

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Typhoid FeverAka: 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
  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. Pulse-Temperature Dissociation (uncommon)
    2. 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. 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)
  10. Complications (occurs in 10-15% of cases)
    1. Gastrointestinal Bleeding (2-10% of cases)
    2. Bowel perforation
    3. Typhoid encephalopathy
  11. 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
  12. 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

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