Typhus- Typhoid Fever

Pathogen

Salmonella typhi, is the typhus pathogen, a gram-negative staph bacterium. A similar clinical picture can also be caused by Salmonella paratyphi.

Transmission

Humans are the only host of the typhus pathogen. Transmission occurs when water has been contaminated by fecal matter or if food is contaminated. People who excrete it constantly in their stool without showing any symptoms pose a great risk.

Clinical picture

Only a small number of pathogens suffice to provoke the typical clinical picture for typhus or typhoid fever. After an incubation period of one to three weeks there is a gradual onset of fever to more than 40C° without the chills. The patient is seriously ill and numbed (typhos= foggy), has bradycardia (a slow pulse) and after experiencing constipation in the early stage comes down with a typical stool which is very soft. The liver and the spleen swell up.

During the second and third week of the disease massive intestinal bleeding or intestinal perforation (intestinal rupture) can occur.

Frequently the course of the disease is quite mild.

Therapy

Therapy is done with antibiotics. Chinolones are added (for adults) and cephalosporines (for children). The danger posed by the antibiotic therapy is that constant excretion is enforced. Even when there is no antibiotic treatment there is generally spontaneous improvement three weeks later.

Even when the disease has been overcome, 2-5% of the patients continue to excrete the typhus pathogen in their stool. In these cases long-term treatment is done with antibiotics. In some cases the gallbladder is removed because the bacteria tend to nest there and cannot be removed with antibiotics.

Complications

Brain abscesses, brain swelling with meningitis-like symptoms, intestinal bleeding, intestinal perforations, and infection of the heart muscles, pneumonia and sepsis.

The mortality rate under antibiotic therapy is approximately 1%.