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Typhoid fever
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Typhoid fever

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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Synopsis

Salmonellosis is caused by a group of gram-negative bacilli. Salmonella enterica serotype typhi and Salmonella enterica serotype paratyphi A, B and C produce the most severe forms of the illness (typhoid and paratyphoid fevers) and are found in most parts of the world except in industrialized regions (United States, Canada, western Europe and Japan). Unlike non-typhoidal Salmonella, typhoid and paratyphoid are strictly human diseases and transmitted via fecal-oral transmission between humans.

The incubation period for typhoid or paratyphoid is 6-30 days. The initial symptoms of typhoid and paratyphoid fevers include the acute or gradual onset of abdominal pain and tenderness, fever, chills, sweating, headache, anorexia, weakness, cough, sore throat, dizziness, and myalgias. Fever develops slowly beginning as low grade and rising to temperatures of 102°F -104°F (39°C-40°C) by the fourth day. This usually progresses to a severe illness with bacteremia and high fever that may last for weeks. Hepatosplenomegaly is common. Some patients will develop a rash of erythematous papules on the trunk (rose spots), and some will suffer altered mental status. Bowel perforation can rarely be seen. Intestinal hemorrhage, meningitis, chondritis, cholecystitis, pyelonephritis, orchitis, typhoid hepatitis, pneumonia, localized abscesses, endocarditis, and myocarditis are also complications.

In the United States, 75% of cases occur in patients aged younger than 30. Untreated, typhoid fever carries a 10%-20% mortality rate. In 15%-20% of treated patients, there is relapse after 2 weeks.

Although typhoid fever is rare in the United States, 9 cases of typhoid fever were documented in California and Nevada between April and July of 2010, with 7 of the patients requiring hospitalization. The US Centers for Disease Control and Prevention (CDC) linked the majority of cases to the consumption of frozen mamey (also called "zapote" or "sapote"), a tropical fruit pulp product used in milkshakes and smoothies.

The CDC has classified drug-resistant nontyphoidal Salmonella and drug-resistant Salmonella serotype typhi as serious concerns. They note that 67% of S. typhi are drug-resistant.

See Salmonellosis for discussion of serotypes Salmonella typhimurium and Salmonella enteritidis.

Codes

ICD10CM:
A01.00 – Typhoid fever, unspecified

SNOMEDCT:
4834000 – Typhoid fever

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Last Reviewed: 03/01/2017
Last Updated: 03/01/2017
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Typhoid fever
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Typhoid fever : Cough, Diarrhea, Fever, Headache, Constipation, Diffuse abdominal pain, Poor sanitation, Anorexia, Myalgia, WBC decreased, RBC decreased
Clinical image of Typhoid fever
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