Typhoid fever

Typhoid fever is an illness caused by the gram negative bacteria salmonella typhi. Spread is faeco-oral and it is endemic in many developing countries.

Usual incubation period is 7 to 14 days (range 30 to 60)

Symptoms and signs include:
  • fever (95%)
  • anorexia (70%)
  • hepatomegaly (40%)
  • vomiting (40%)
  • abdominal pain (30%)
  • diarrhoea
  • initial constipation
  • headache
  • splenomegaly
Complications include
  • encephalitis
  • GI bleeds
  • intestinal perforation

Risk of severe illness is greater in those who are immunicompromised or who have decreased gastric acid (eg on PPIs)

Diagnosis: gold standard is blood culture; the Widal test is no longer recommended due to low specificity and sensititivity. Urine and stool cultures may be positive from the second week of infection.

  • ciprofloxacin, azithromycin or ceftriaxone 
  • rehydration

A vaccine is available.

Less than 1% of those treated die; untreated mortality is around 10%.

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