Typhoid Fever

Kirsten Mueller
AP Biology
Period 4/5
What is Typhoid Fever?
 Typhoid Fever is a life-
threatening illness caused by
the bacterium Salmonella
Typhi.
 Typhoid Fever is also known
as enteric fever, bilious fever
or Yellow Jack.
 It is a gram-negative short
bacillus that is motile due its
flagellum.
 Gram-negative bacteria are
pathogenic, meaning they can
cause disease in a host
organism.
Typhoid Fever
 About 400 cases of
Typhoid Fever occur
each year in the United
States.
 70% of these cases are
acquired while traveling
internationally.
 Typhoid Fever affects
approximately 12.5
million people each year.
Typhoid Fever
 According to the doctor-produced
website of www.MedicineNet.com,
patients with acute illness can
contaminate the surrounding water
supply through their feces which has a
very high concentration of the bacteria.
 After the acute, illness about 3%-5% of
the people become carriers of the
disease. Sometimes the illness goes
unnoticed but these people become
long-term carriers.
 The bacteria will multiply while in the
gallbladder, bile ducts and the liver and
then pass into the bowel.
The Disease
 After ingested, the bacteria
temporarily enter the blood
stream and travel to the small
intestine.
 White blood cells carry the
disease to the liver, spleen
and bone marrow where it
reproduces and reenters the
blood stream.
Typhoid Nodule in the liver
 The bacteria then invades the
gallbladder, biliary system,
and the lymphatic tissue of the
bowel.
Affected Organs
 Abdominal Cavity
including:
 Liver
 Gallbladder
 Stomach
 Small intestine
 Large intestine
How is Typhoid Fever Contracted?
 Typhoid Fever is contracted
by the ingestion of the bacteria
in contaminated food or water.
 The bacteria itself only lives in
humans and is carried through
the blood stream and intestinal
tract.
 Both ill people and carriers of
the disease spread the
Typhoid bacteria through their
feces.
Transmission
 Typhoid can be passed
through animals, only
through humans.
 Flies however, are known to
help transmit the disease
because when they land on
human excrement, it
remains on their
appendages and can be
transmitted when they land
on something else.
International History of Typhoid
Fever
 Around 430-426 B.C. it is
believed that Typhoid Fever
killed 1/3 of the population in
Athens.
 This was long disputed but
after a DNA discovery in 2006,
it was determined that it was
the Typhoid Fever bacterium.
 Between 2004-2005 an
outbreak in the Dominican
Republic occurred with 42,000
cases and 214 deaths.
National History of Typhoid
Fever
 In the late 19th century, a
typhoid fever outbreak in
Chicago occurred killing
65 per 100,000 people.
 In 1891, the worst
mortality rates were 174
per 100,000 people.
 In 1907, the first
American carrier was
discovered - Mary Mallon
aka Typhoid Mary.
United States
 According to statistics
from the Centers for
Disease Control have
proved that the
chlorination of drinking
water has led to a
decrease in the
transmission of typhoid
fever in the United States.
Where in the World?
 Typhoid Fever is very
common around the
world except in
industrialized nations
such as the United
States, Canada and
Japan.
Symptoms
 Symptoms include:
 Fevers up to 103° or 104°
 Weakness
 Headaches
 Poor appetite
 Generalized aches and
pains
 Diarrhea
 Occasionally a rash of flat,
rose-colored spots Typhoid Fever Rash
 Discomfort
 Abdominal Tenderness
Symptoms Continued
 Constipation, then
diarrhea
 Bloody Stools
 Nosebleed
 Chills
 Delirium
 Confusion
 Agitation
 Fluctuating moods
 Hallucinations
Stages of Typhoid Fever
 Classically, the untreated
typhoid fever is broken down
into four different stages, each
lasting about a week.
 Stage One:
 A slowly rising temperature
 Relative bradycardia
(unusually slow heart rate),
malaise (discomfort or
uneasiness), headache and
cough.
 In ¼ of cases, epistaxis
(acute hemorrhage from the
nostril, nasal cavity, or
nasopharynx) can occur.
Stages of Typhoid Fever
 Stage Two:
 Continuing high fever
 Extremely distended
abdomen
 Considerable weight loss
 Bradycardia continues
 Dicrotic pulse wave
 Delirium is frequent,
frequently calm and
sometimes agitated.
Stages of Typhoid Fever
 Stage Three:
 A number of complications can occur:
 Intestinal hemorrhage due to
bleeding
 Intestinal perforation

 Encephalitis (inflammation of the

brain)
 Fever is still very high

 Dehydration occurs and

increases delirium
 Lies motionless with eyes half-
opened
 Stage Four:
 Defervescence (very high fever)
commences that continues into the
fourth week.
Complications
 Death occurred from the
development of other
complications such as:
 Overwhelming infections
 Pneumonia
 Intestinal bleeding
 Intestinal perforation
 Kidney Failure
 Peritonitis (inflammation of the
peritoneum, the thin membrane
that lines the abdominal wall
and covers most of the organs
of the body)
Complications Continued
 Inflammation of the
pancreas
 Infections of the spine
 Inflammation of the
membranes surrounding
the spinal cord and brain
(meningitis)
 Inflammation of the heart
muscle
 Psychiatric problems
Diagnosis
 Diagnosis is made by
blood, bone marrow, or
stool.
 The Widal test is
commonly used to
diagnose Typhoid.
 Looks for salmonella
antibodies against
antigens O-somatic and
H-flagellar)
Exams and Tests
 An elevated white blood cell
count
 A blood culture the shows
the bacteria
 A stool culture
 An ELISA test to show the
Vi antigen
 A platelet count (low platelet
count)
 A fluorescent antibody study
Antibody Testing
 Fluorescent Antibody
Test
 The test checks for
the antibody specific
to the S. Typhi
bacterium.
Antigen Testing
 Enzyme-linked
immunosorbent assay
(ELISA)
 The blood test looks
for the antigen
specific to the typhoid
bacteria.
Carriers of Typhoid
 3%-5% of people who
have been infected
become carriers of the
disease.
 Carriers are treated with
prolonged antibiotics.
 Removal of the
gallbladder or the site of
Typhoid Carrier undergoes treatment the infection will usually
cure the patient.
Carriers of Typhoid Fever
 A carrier is usually a healthy
person who survived the
disease but in whom the
bacteria are able to survive
without causing further
symptoms.
 Carriers continue to spread the
disease through their
excrement without realizing it.
 It is believed that Mary Mallon
never actually had the disease
however, her mother had
typhoid while pregnant with her.
Typhoid Mary
 She infected 47 people and
killed 3
 She constantly changed her
employment but the members of
the household always got sick.
 She was forced into containment
for two years and then released
under the conditions that she
could no longer be a cook.
 She assumed a false name and
began cooking again and of
course, infecting numerous
people.
 She was forced into life-time
containment where she died 26
years later of pneumonia.
Famous People with Typhoid
Fever
 Abigail Adams, wife of
President John Adams
 Martha Bulloch, mother of
Theodore Roosevelt
 Stephan A. Douglas
 Wilbur Wright
 William Wallace Lincoln,
son of Abraham Lincoln
 Archduke Karl Ludwig of
Austria
More Famous People
 Albert of Saxe-Coburg-
Gotha, British prince
consort, Queen Victoria’s
husband
 Henry Frederick, Prince
of Wales, original heir ot
the throne of James I of
England
 Mark Hanna, US
politician
Heterozygous Advantage
 Those with cystic fibrosis
are believed to have a
natural resistance to
Typhoid Fever.
 The CFTR protein is
present in both the lungs
and the intestinal tract. The
mutated protein in CF
prevents entry of the
typhoid bacteria into the
body through these
membrane.
Treatment
 Typhoid is treated with an
antibiotic that kills the
Salmonella bacteria.
 With antibiotics,
improvement can be seen
in 1-2 days and recovery
in 7-10 days.
 Intravenous fluids and
Typhoid Vaccine electrolytes may also be
given to patients.
Treatment
 In most cases typhoid fever
is not fatal.
 Antibiotics such as
ampicillin, chloramphenicol,
trimethethoprim-
sulfamethoxazole, and
ciprofloxican.
 These antibiotics have been
used in most developed
countries.
Resistance
 Resistance to ampicillin,
chloramphenicol, trimethoprim-
sulfamethoxazole and
streptomycin are common
drugs used against Typhoid
but have now become
resistant.
 These drugs have not been
used in over 20 years.
 Typhoid that is resistant to
multiple drugs is known as
multidrug-resistant typhoid
(MDR typhoid).
Chloramphenicol
 Chloramphenicol was
the original prescribed
drug to patients with
Typhoid Fever.
 However due to
certain side effects,
this drug has been
replaced by others. Chloramphenicol
Choice of Drugs
 The type of antibiotic
prescribed is based on
the region in which the
disease originates.
 Bacteria from certain
areas in South America
show a resistivity to many
antibiotics.
 Relapses of the disease
are dealt with by the
administration of
antibiotics.
Improvement
 With the use of
antibiotics, improvement
can come usually in the
fourth week.
 The fever generally
decreases back down to
normal temperature in 7-
10 days.
 Signs and symptoms
however, can return in up
to 2 weeks after the fever
has subsided.
Fatality
 Before the antibiotic,
the death rate was
20%.
 Antibiotics have
reduced the fatality
rate 1%-2%.
Antibiotic to prevent Typhoid Fever
How can Typhoid be avoided?
 Avoid risky foods or drinks
 Get vaccinated
 Use only clean water
 Ask for drinks without ice
unless you know where it’s
coming from
 Only eat foods that have
been thoroughly cooked
 Avoid raw fruits and
vegetables
 Avoid food and drinks from
street vendors
Attention Travelers!
 Vaccines are now
available to those
who are traveling
abroad to
underdeveloped
countries.
Who should get the Typhoid Vaccine?

 Travelers to parts of the

world where Typhoid
Fever is very common.
 People who work with or
come in contact with a
carrier of the disease.
 Laboratory analysts who
work with the Salmonella
Typhi bacteria.
Vaccinations
 The vaccine was
discovered in 1897 by
Almroth Edward Wright.
 There are two types of
vaccinations available:
 Inactive (killed) vaccine in a
shot (Vi capsular
polysaccharide vaccine)
 Live, attenuated
(weakened) vaccine taken
orally (Ty21a)

Typhoid Vaccination
VaccinationShot
 Administered at least
2 weeks before
traveling.
 Vaccination only lasts
2 years so booster
shots are needed for
those still at risk.
 Not for children under
2 years of age.
VaccinationOral
 Not for children under the
age of 6.
 4 administrations, each
given 2 days apart.
 Last administration
should be given at least a
week before traveling.
 A booster shot is needed
every 5 years.
Vaccinations
Total time
needed to
Number of Minimum age
Time between set aside Booster needed
Vaccine Name How given doses for
doses for every...
necessary vaccination
vaccinatio
n

Ty21a (Vivotif
Berna,
Swiss
1 capsule
Serum 4 2 days 2 weeks 6 years 5 years
by mouth
and
Vaccine
Institute)

ViCPS
(Typhim
Vi, Injection 1 N/A 2 weeks 2 years 2 years
Pasteur
Merieux)
Risks of the VaccinationShot
 Fever (1 per 100
people)
 Headache (3 per 100
people)
 Redness or swelling
at the site of injection
(7 per 100 people)
Risks of VaccinationOral
 Fever (5 per 100
people)
 Headache (5 per 100
people)
 Abdominal
discomfort, nausea,
vomiting or rash are
very rare
Reactions to Vaccination
 Allergic reactions can be a
result of the vaccination.
 If a severe reaction occurs
such as:
Difficultybreathing
Hoarseness
Wheezing
Hives
Paleness
Weakness
Increased heart rate
Dizziness
Call a doctor or seek medical
treatment immediately
Video
 http://www.youtube.com/watch?v
=mQunnRZOzJ8&feature=related
 www.youtube.com/watch?v=
vQPrSRSVfIM
Sources
 www.MedicineNet.com
 http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfeve
r_g.htm
 Dr. Adrian Popp, M.D. from the Long Island Infectious
Disease Associates, P.C.
 www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.ht
m
 http://en.wikipedia.org/wiki/Typhoid_fever
 www.mayoclinic.com/health/typhoid-fever/DS00538/DSE
CTION=9