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Typhoid fever, also known simply as typhoid, is a bacterial illness caused by Salmonella typhi. ^[1]

Symptoms typically begin, six to thirty days after exposure to food or water, contaminated with the feces of an infected person. ^[2]

Symptoms

Early symptoms may vary from mild to severe. ^{[3] [4]} Usually, there is a gradual onset of a high fever over several days; ^[3] weakness, abdominal pain, constipation, headaches, and mild vomiting. ^{[4] [5]}

Other symptoms

Some people will develop a skin rash, with rose colored spots. ^[4]

Severe cases and carriers

In severe cases there may be confusion. ^[5] Without treatment, symptoms may last weeks or months. ^[4]

Carriers

Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. ^[2]

The cause is the bacterium Salmonella Typhi, that grows in the intestines and blood. ^{[4] [5]}

Spread

Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person.

Risk factor

Risk factors include poor sanitation and poor hygiene. ^[1]

Risk factor 2

Those who travel in the developing world are also at risk. ^[5]

Because symptoms are similar to those of many other infectious diseases, ^[5] diagnosis requires either culturing the bacteria, or detecting the bacterium's DNA in the blood, stool, or bone marrow. ^{[4] [1] [6]}

Bone marrow testing

Culturing the bacterium can be difficult, so ^[7] bone marrow testing is the most accurate. ^[6]

The chlorination of public drinking water led to the sharp reduction of typhoid in developed nations. ^[8] In typhoid-endemic countries,

Typhoid vaccines have been shown to prevent 40 to 90% of cases during the first two years, ^[9] and may have some effect for up to seven years. ^[1]

Travel to endemic areas

Vaccination is recommended for those at high risk, or people traveling to areas where the disease is common. ^[2]

Other efforts

Other efforts to prevent the disease include providing clean drinking water, good sanitation, and handwashing. ^{[4] [2]}

Infected persons quarantine

Until it has been confirmed that an individual's infection is cleared, the individual should not prepare food for others. ^[4]

The disease is treated with antibiotics such as azithromycin, fluoroquinolones, or third generation cephalosporins. ^[1]

Resistance

Resistance to these antibiotics has been developing, which has made treatment more difficult. ^{[1] [10]}

In 2015, there were 12.5 million new cases worldwide. ^[11]

Epidemiology - geography

The disease is most common in India. ^[1]

Epidemiology - demographic

Children are most commonly affected. ^{[1] [2]}

Rates of disease decreased in the developed world in the 1940s, as a result of improved sanitation, and use of antibiotics to treat the disease. ^[2]

The risk of death may be as high as 20% without treatment, and 1 to 4% with treatment. ^[2]

The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mary.

History 2

In 1907, she was the first typhoid carrier identified and traced, while working as a cook in New York. She was associated with 53 cases and three deaths. ^[12]

History 3

She died of pneumonia after 26 years in quarantine.