Typhoid Injection Disease

Typhoid fever is a bacterial infection of the blood and intestinal tract, spread by feces in water. Worldwide, of the nearly 20 million infected, some 600,000 people die. Typhoid is ordinarily curable, although some strains are becoming resistant to antibiotics. About 400 cases are reported in the U.S. each year, 75% of those from people who were infected while traveling internationally.

Causes

• Typhoid fever is caused by Salmonella typhi, a bacteria passed in the urine and feces of infected people. Infection can come from eating and drinking food and beverages handled by a contaminated person. Another source of infection is drinking water that has been contaminated by sewage containing the bacteria.
  About 3% of infected people, mostly older women with gallbladder disease, continue to carry the bacteria after they recover.
  In some countries, typhoid is spread by shellfish taken from water contaminated by the bacteria.
  When chlorinated water is widely available, contaminated food is the usual source of infection.
  The disease is usually associated with less industrial countries suffering from flooding, unsafe drinking water and inadequate disposal of sewage.
  Cases reported each year in Canada and the U.S. were mainly transmitted by immigrants who were infected when they arrived.

Symptoms

• After entering a person's body, the bacteria multiply, spreading into the bloodstream and intestines. Symptoms appear from one to three weeks after exposure and can be mild to severe. They include fever as high as 104 degrees Fahrenheit, headache, malaise, anorexia, stomach pains, diarrhea or constipation, rose-colored spots on the chest, and enlarged liver and spleen. Rare symptoms include intestinal bleeding, delirium and bleeding from the rectum.
  Typhoid bacteria in the blood can travel to the lungs, bones, heart, muscles, kidneys, genitals or urinary tract.
  Thirty percent of typhoid-related deaths are caused by intestinal perforation, which causes bacteria in the intestines to spill into the abdominal cavity. Deaths are also attributed to pneumonia, seizures, delerium and coma.

Treatment

• The antibiotics usually prescribed are trimethoprim-sulfamethoxazole, ampicillin and ciprofloxacin. People treated with antibiotics usually get better in two or three days. Left untreated, the disease can linger for weeks. As many as 20% of those not treated will die.
  Older antibiotics, including amoxicillin, chloramphenicol or cotrimoxazole, can result in a relapse of symptoms in a few weeks. This relapse is less severe and tends to clear up quickly with more treatment.

Prevention

• The World Health Organization encourages people to wash their hands before preparing food and after using the toilet.
  Provisions should be made for safe water supplies and proper sanitation systems.
  Those who carry the disease should be prevented from handling food.
  Vaccines are available for high-risk areas, but they are not recommended except for those who will likely have prolonged exposure to high-risk areas with potentially contaminated food and water. Current vaccines give about 70% protection for two to four years.

Travel in Areas at Risk

• • You might be at risk if you travel to poorer areas of Asia, Africa and Latin America.
  • Keep your hands clean and pay attention to what you eat and drink.
  • Avoid food sold by street vendors.
  • Drink only bottled water or water that has been boiled for one minute.
  • Bottled carbonated water is better than bottled non-carbonated water. Ask for drinks without ice. Avoid flavored ices that might have been made with contaminated water.
  • Boil, cook or peel all food.
  • Eat food while it's hot. Keep flies away from food.
  • Avoid salads and raw vegetables that cannot be peeled.