Typhoid fever, also known as Salmonella typhi or commonly just typhoid,^[1] is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus (or cloaca) during defecation of an infected person.^[2] The bacteria then perforate through the intestinal wall and are phagocytosed Phagocytosis is the cellular process of phagocytes and protists of engulfing solid particles by the cell membrane to form an internal phagosome. Phagocytosis is a specific form of endocytosis involving the vesicular internalization of solid particles, such as bacteria, and is therefore distinct from other forms of endocytosis such as the vesicular by macrophages Macrophages are white blood cells within tissues, produced by the differentiation of monocytes. Human macrophages are about 21 micrometres (0.00083 in) in diameter. Monocytes and macrophages are phagocytes, acting in both non-specific defense (innate immunity) as well as to help initiate specific defense mechanisms (adaptive immunity) of. It is caused by the bacterium Salmonella typhi ^[3] The organism is a Gram-negative Gram-negative bacteria are those bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color. The test itself is useful in classifying two distinct types of bacteria based on the structural short bacillus that is motile due to its peritrichous flagella A flagellum is a tail-like projection that protrudes from the cell body of certain prokaryotic and eukaryotic cells, and functions in locomotion. There are some notable differences between prokaryotic and eukaryotic flagella, such as protein composition, structure, and mechanism of propulsion. An example of a flagellated bacterium is the ulcer-. The bacterium grows best at 37 °C Celsius is a temperature scale that is named after the Swedish astronomer Anders Celsius (1701–1744), who developed a similar temperature scale two years before his death. The degree Celsius (°C) can refer to a specific temperature on the Celsius scale as well as a unit to indicate a temperature interval (a difference between two temperatures/99 °F Fahrenheit is the temperature scale proposed in 1724 by, and named after, the physicist Daniel Gabriel Fahrenheit . Today, the temperature scale has been replaced by the Celsius scale in most countries. It is still in use in few nations, such as United States and Belize – human body temperature.

This fever received various names, such as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, pythogenic fever, etc. The name of " typhoid " was given by Louis in 1829, as a derivative from typhus.

The impact of this disease falls sharply with the application of modern sanitation techniques.

Signs and symptoms

Typhoid fever is characterized by a slowly progressive fever Fever is a common medical sign characterized by an elevation of temperature above the normal range of 36.5–37.5 °C (98–100 °F) due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering as high as 40 °C (104 °F), profuse sweating, gastroenteritis Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute diarrhea. It can be transferred by contact with contaminated food and water. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins, parasites, or an, and nonbloody diarrhea Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated. Less commonly, a rash A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, dry, cracked or blistered, swell and may be painful. The causes, and therefore treatments for rashes, vary widely. Diagnosis of flat, rose-colored spots may appear.^[4]

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia Bradycardia , as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart. It sometimes results in fainting,, malaise Malaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell", headache and cough. A bloody nose (epistaxis Epistaxis is the relatively common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, more likely to require medical attention). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia Leukopenia is a decrease in the number of white blood cells (leukocytes) found in the blood, which places individuals at increased risk of infection, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella Salmonella is a genus of rod-shaped, Gram-negative, non-spore forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which project in all directions . They are chemoorganotrophs, obtaining their energy from oxidation and reduction reactions using organic sources, and are facultative typhi or paratyphi. The classic Widal test is negative in the first week.

In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia Bradycardia , as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart. It sometimes results in fainting, (sphygmothermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium Delirium is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior. It typically involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. There are rhonchi It is an abnormal or adventitious sound heard when listening to the chest as the person breathes. These are low pitched, continuous sounds that are similar to wheezes. Some have described the sounds as being similar to the sound of a donkey's hooves as they run. They are present when an airway is partially obstructed owing to secretions, mucosal in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly Hepatosplenomegaly is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). Hepatosplenomegaly can occur as the result of acute viral hepatitis or infectious mononucleosis, or it can be the sign of a serious and life threatening lysosomal storage disease) and tender, and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major symptom of this fever is the fever Fever is a common medical sign characterized by an elevation of temperature above the normal range of 36.5–37.5 °C (98–100 °F) due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering usually rises in the afternoon up to the first and second week.)

In the third week of typhoid fever, a number of complications can occur:

• Intestinal hemorrhage due to bleeding in congested Peyer's patches Peyer's patches are organized lymphoid tissue, named after the 17th-century Swiss anatomist Johann Conrad Peyer. They are aggregations of lymphoid tissue that are usually found in the lowest portion of the small intestine ileum in humans; as such, they differentiate the ileum from the duodenum and jejunum; this can be very serious but is usually not fatal.
• Intestinal perforation in the distal ileum The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia Sepsis is a serious medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, more aptly applied to or diffuse peritonitis Peritonitis is an inflammation of the peritoneum, the serous membrane which lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process sets in.
• Encephalitis Patients with encephalitis suffer from fever, headache and photophobia with weakness and seizures also common. Less commonly, stiffness of the neck can occur with rare cases of patients also suffering from stiffness of the limbs, slowness in movement and clumsiness depending on which specific part of the brain is involved. Nuchal rigidity may lead
• Metastatic abscesses, cholecystitis Cholecystitis is often caused by cholelithiasis , with choleliths most commonly blocking the cystic duct directly. This leads to inspissation (thickening) of bile, bile stasis, and secondary infection by gut organisms, predominantly E. coli and Bacteroides species, endocarditis Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures which may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices. Endocarditis is characterized by a prototypic lesion, the vegetation, and osteitis endocrine bone disease: Osteitis fibrosa cystica

The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing (defervescence). This carries on into the fourth and final week.

Cause

Transmission

Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. According to statistics from the United States Center for Disease Control The Centers for Disease Control and Prevention is a United States federal agency under the Department of Health and Human Services based in Atlanta, Georgia. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other, the chlorination Chlorination is the process of adding the element chlorine to water as a method of water purification to make it fit for human consumption as drinking water. Water which has been treated with chlorine is effective in preventing the spread of waterborne disease of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S.

A person may become an asymptomatic carrier An asymptomatic carrier is a person or other organism that has contracted an infectious disease, but who displays no symptoms. Although unaffected by the disease themselves, carriers can transmit it to others. A number of animal species can also act as carriers of human disease of typhoid fever, suffering no symptoms, but capable of infecting others. According to the Centers for Disease Control The Centers for Disease Control and Prevention is a United States federal agency under the Department of Health and Human Services based in Atlanta, Georgia. It works to protect public health and safety by providing information to enhance health decisions, and it promotes health through partnerships with state health departments and other approximately 5% of people who contract typhoid continue to carry the disease after they recover. The most famous asymptomatic carrier was Mary Mallon Mary Mallon , also known as Typhoid Mary, was the first person in the United States to be identified as a healthy carrier of typhoid fever. Over the course of her career as a cook, she is known to have infected 53 people, three of whom died from the disease. Her notoriety is in part due to her vehement denial of her own role in spreading the (commonly known as "Typhoid Mary"), a young cook who was responsible for infecting at least 53 people with typhoid, three of whom died from the disease.^[5] Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic".

Many carriers of typhoid were locked into an isolation ward never to be released in order to prevent further typhoid cases. These people often deteriorated mentally, driven mad by the conditions they lived in.^[6]

Heterozygous advantage

It is thought that cystic fibrosis Cystic Fibrosis is a common hereditary disease which affects the entire body, causing progressive disability and often early death. The name cystic fibrosis refers to the characteristic scarring (fibrosis) and cyst formation within the pancreas, first recognized in the 1930s. Difficulty breathing is the most serious symptom and results from may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever.^[7] The CFTR protein is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.

Diagnosis

Diagnosis is made by any blood Blood culture is microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream, bone marrow Bone marrow is the flexible tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells. It constitutes 4% of total body weight, i.e. approximately 2.6 kg in adults or stool Human Feces , also known as stools, is the waste product of the human digestive system and varies significantly in appearance, depending on the state of the whole digestive system, influenced and found by diet and health. Normally stools are semisolid, with a mucus coating. Small pieces of harder, less moist feces can sometimes be seen impacted on cultures Culture is a term that has different meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions. However, the word "culture" is most commonly used in three basic senses: and with the Widal test (demonstration of salmonella antibodies Antibodies are gamma globulin proteins that are found in blood or other bodily fluids of vertebrates, and are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses. They are typically made of basic structural units—each with two large heavy chains and two small light chains—to form, for example, against antigens An antigen is a molecule recognized by the immune system. Originally the term came from antibody generator and was a molecule that binds specifically to an antibody, but the term now also refers to any molecule or molecular fragment that can be bound by a major histocompatibility complex and presented to a T-cell receptor. "Self" O-somatic and H-flagellar). In epidemics In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is "expected," based on recent experience (the number of new cases in the population during a specified period of time is called the "incidence rate"). (An epizootic is the and less wealthy countries, after excluding malaria Malaria is a mosquito-borne infectious disease caused by a eukaryotic protist of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas , Asia, and Africa. Each year, there are approximately 350–500 million cases of malaria, killing between one and three million people, the majority of whom, dysentery Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the feces with fever and abdominal pain. If left untreated, dysentery can be fatal or pneumonia Pneumonia is an inflammatory condition of the lung. It is often characterized as including inflammation of the parenchyma of the lung and abnormal alveolar filling with fluid (consolidation and exudation), a therapeutic trial time with chloramphenicol Chloramphenicol is a bacteriostatic antimicrobial. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines is generally undertaken while awaiting the results of Widal test and cultures of the blood and stool.^[8]

The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.^[9]

Prevention

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to preventing typhoid.

A vaccine against typhoid fever was developed during World War II by Ralph Walter Graystone Wyckoff.^[10] There are two vaccines currently recommended by the World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the for the prevention of typhoid:^[11] these are the live, oral Ty21a vaccine (sold as Vivotif Berna) and the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline). Both are between 50% to 80% protective and are recommended for travelers to areas where typhoid is endemic. Boosters are recommended every 5 years for the oral vaccine and every 2 years for the injectable form. There exists an older killed whole-cell vaccine that is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use, because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection).^[11]

Treatment

The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general. Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin^[9][12] otherwise, a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice.^[13][14][15] Cefixime is a suitable oral alternative.^[16][17]

Typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases^{[citation needed]}. In some communities, however, case-fatality rates may reach as high as 47%.^{[citation needed]}

The common treatment of Typhoid is Mucomelt-Forte which is the combination of Cefixime with Acetylcysteine. Cefixime is the third generation cephalosporin antibiotic which breaks the cell wall of bacteria that is Salmonella typhi and acetylcysteine neutralize the endotoxin which is released by the bacteria as a waste product of metabolism.This endotoxin cause rise in body temperature which is the main symptom of typhoid.

Resistance

Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin is now common, and these agents have not been used as first line treatment now for almost 20 years.^{[citation needed]} Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone. It has also been suggested Azithromycin is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone.^[18] Azithromycin significantly reduces relapse rates compared with ceftriaxone.

There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method.^[19] It is not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent on disc testing and cannot test for MICs.

Epidemiology

With an estimated 16–33 million cases of annually resulting in 216,000 deaths in endemic areas, the World Health Organization identifies typhoid as a serious public health problem. Its incidence is highest in children and young adults between 5 and 19 years old.^[20]

History

Around 430–424 BC, a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. The balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak. The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever.^[21] Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.^[22] The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of Attica was besieged within the Long Walls and lived in tents.

In the late 19th century, typhoid fever mortality rate in Chicago averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 people.^[23] The most notorious carrier of typhoid fever—but by no means the most destructive—was Mary Mallon, also known as Typhoid Mary. In 1907, she became the first American carrier to be identified and traced. She was a cook in New York. She is closely associated with fifty-three cases and three deaths.^[24] Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.

In 1897, Almroth Edward Wright developed an effective vaccine. In 1909, Frederick F. Russell, a U.S. Army physician, developed an American typhoid vaccine and two years later his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military.

Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. Today, incidence of typhoid fever in developed countries is around 5 cases per 1,000,000 people per year.

An outbreak in the Democratic Republic of Congo in 2004–05 recorded more than 42,000 cases and 214 deaths.^[20]

Typhoid fever was also known as suette milliaire in nineteenth-century France.

Famous victims

Famous people who have had the disease include:

• M.D Hashimoto Hakaru, The discoverer Of Autoimmune Thyroiditis Hashimoto's thyroiditis. Died in 9 of January , 1934 by Typhoid fever.
• Mary Mallon, more commonly known as Typhoid Mary, survived/carrier
• Abigail Adams, second First Lady of the United States, wife of John Adams, died of typhoid fever on October 28th, 1818.
• Albert of Saxe-Coburg-Gotha, British prince consort, Queen Victoria's husband
• Edward VII, survived
• Princess Victoria of Hesse and by Rhine, survived
• Tadeusz Kosciuszko, hero of the American Revolution and Polish patriot leader, died of Typhoid Fever in Switzerland, 1817.
• Louisa May Alcott, author of Little Women records contracting it in Hospital Sketches
• Charles Darwin, naturalist, during his visit to Chile with HMS Beagle in 1835
• Eugenia Tadolini, a celebrated Italian soprano, who died of the disease in Paris in 1872.
• Leland Stanford Jr. died of typhoid in 1884; his parents founded Stanford University in his memory.
• William Wallace Lincoln, third son of Abraham Lincoln, the 16th President of the United States, died February 20th, 1862 of typhoid fever.
• Mary Todd Lincoln, wife of Abraham Lincoln.
• Wilbur Wright, one of the famous Wright Brothers. Died May 30, 1912 of typhoid fever.
• Frank McCourt, author of Angela's Ashes. In the memoir, he details nearly dying of the disease in 1940 as a ten-year-old in Limerick, Ireland, and his ensuing 4-month-long hospital stay.
• Stephen Douglas, politician and 1860 Presidential Runner-Up
• Dr HJH 'Tup' Scott, captain of the 1886 Australian cricket team that toured England, died of typhoid in 1910.^[25]

In fiction

• Gilbert Blythe (of the Anne of Green Gables series) almost dies of typhoid fever in Anne of the Island by L.M. Montgomery.
• Walter Blythe (son of Anne and Gilbert Blythe in the latter Anne of Green Gables books) was in recovery from typhoid in "Rilla of Ingleside" and this is seen as the reason why he does not enlist at the onset of WWI
• Johann "Hanno" Buddenbrook, in Thomas Mann's novel, Buddenbrooks, dies of typhoid fever, and the book includes a long medical description of the disease and its effects.
• John H. Watson (Sherlock Holmes' famed companion) nearly died of typhoid contracted in India, and returned to England for convalescence – where he first met the detective.
• Scarlet O'Hara's mother and sisters in Gone With the Wind
• Suttree in the Cormac McCarthy novel of the same name nearly dies of typhoid fever in the final scenes of the novel.
• In the 1950 western Stars in My Crown, the town is devastated by typhoid spread by a school's well.

See also

• Kauffman-White classification

References

1. ^ MedlinePlus Encyclopedia Typhoid fever
2. ^ Giannella RA (1996). "Salmonella". Baron's Medical Microbiology (Baron S et al., eds.) (4th ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.1221.
3. ^ http://www.cdc.gov/ncidod/dbmd/diseaseinfo/TyphoidFever_g.htm
4. ^ CDC Disease Info typhoidfever_g
5. ^ "'Typhoid Mary' Dies Of A Stroke At 68. Carrier of Disease, Blamed for 51 Cases and 3 Deaths, but She Was Held Immune". New York Times. November 12, 1938. http://select.nytimes.com/gst/abstract.html?res=F10D15FE3859117389DDAB0994D9415B888FF1D3. Retrieved 2010-02-28. "Mary Mallon, the first carrier of typhoid bacilli identified in America and consequently known as Typhoid Mary, died yesterday in Riverside Hospital on North Brother Island."
6. ^ BBC on Long Grove Hospital Surrey GB url: http://news.bbc.co.uk/today/hi/today/newsid_7523000/7523680.stm
7. ^ Weinberg ED (2008). "Survival advantage of the hemochromatosis C282Y mutation". Perspectives in biology and medicine 51 (1): 98–102. doi:10.1353/pbm.2008.0001. PMID 18192769. http://muse.jhu.edu/cgi-bin/resolve_openurl.cgi?issn=0031-5982&volume=51&issue=1&spage=98&aulast=Weinberg.
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10. ^ "Ralph W. G. Wyckoff 1897-1994," Acta Cryst. (1995). A51, 649-650. Accessed online at http://ww1.iucr.org/people/wyckoff.htm on 3/23/2010
11. ^ ^{a b} "Typhoid vaccines: WHO position paper". Wkly. Epidemiol. Rec. 83 (6): 49–59. February 2008. PMID 18260212. http://www.who.int/wer/2008/wer8306/en/index.html.
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13. ^ Soe GB, Overturf GD (1987). "Treatment of typhoid fever and other systemic salmonelloses with cefotaxime, ceftriaxone, cefoperazone, and other newer cephalosporins". Rev Infect Dis (The University of Chicago Press) 9 (4): 719–736. PMID 3125577. http://www.jstor.org/stable/4454162.
14. ^ Wallace MR, Yousif AA, Mahroos GA, et al. (1993). "Ciprofloxacin versus ceftriaxone in the treatment of multiresistant typhoid fever". Eur J Clin Microbiol Infect Dis 12 (12): 907–910. doi:10.1007/BF01992163. PMID 8187784.
15. ^ Dutta P, Mitra U, Dutta S, et al. (2001). "Ceftriaxone therapy in ciprofloxacin treatment failure typhoid fever in children". Indian J Med Res 113: 210–213. PMID 11816954.
16. ^ Bhutta ZA, Khan IA, Molla AM (1994). "Therapy of multidrug-resistant typhoid fever with oral cefixime vs. intravenous ceftriaxone". Pediatr Infect Dis J 13 (11): 990–994. doi:10.1097/00006454-199411000-00010. PMID 7845753.
17. ^ Cao XT, Kneen R, Nguyen TA, Truong DL, White NJ, Parry CM (1999). "A comparative study of ofloxacin and cefixime for treatment of typhoid fever in children. The Dong Nai Pediatric Center Typhoid Study Group". Pediatr Infect Dis J 18 (3): 245–8. PMID 10093945.
18. ^ Effa EE, Bukirwa H (2008). "Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever)". Cochrane Database of Systematic Reviews (1): CD006083. doi:10.1002/14651858.CD006083.pub2. PMID 18843701.
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20. ^ ^{a b} "Typhoid Fever". World Health Organization. http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html. Retrieved 2007-08-28.
21. ^ Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E (2006). "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens". Int J Infect Dis 10 (3): 206–14. doi:10.1016/j.ijid.2005.09.001. PMID 16412683.
22. ^ Shapiro B, Rambaut A, Gilbert M (2006). "No proof that typhoid caused the Plague of Athens (a reply to Papagrigorakis et al.)". Int J Infect Dis 10 (4): 334–5; author reply 335–6. doi:10.1016/j.ijid.2006.02.006. PMID 16730469.
23. ^ "1900 Flow of Chicago River Reversed". Chicago Timeline. Chicago Public Library. http://web.archive.org/web/20070307091435/http://www.chipublib.org/004chicago/timeline/riverflow.html. Retrieved 2007-02-08.
24. ^ "Nova: The Most Dangerous Woman in America". http://www.pbs.org/wgbh/nova/typhoid/letter.html.
25. ^ [1]

Further reading

• Easmon C (2005-04-01). "Typhoid fever and paratyphoid fever". Travel Health. http://www.netdoctor.co.uk/travel/diseases/typhoid.htm. Retrieved 2008-10-05.
• Harrison NG. "Walter Reed and Typhoid Fever, 1897–1911". Univ of Virginia. http://www.hsl.virginia.edu/historical/medical_history/typhoid. Retrieved 2008-10-05.
• Nicolson, Stuart (2008-06-26). "Typhoid left city (Aberdeen) 'under siege'". BBC News. http://news.bbc.co.uk/2/hi/uk_news/scotland/7471198.stm. Retrieved 2008-10-05.
• O'Hara C (2006-01-26). "Typhoid Fever Led To The Fall Of Athens". Elsevier. http://www.medicalnewstoday.com/articles/36578.php. Retrieved 2008-10-05.

External links

• CDC Disease Info typhoidfever_g

Categories: Intestinal infectious diseases | Conditions diagnosed by stool test | Water-borne diseases

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