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typhoid fever acute, generalized infection caused by Salmonella typhi. The main sources of infection are contaminated water or milk and, especially in urban communities, food handlers who are carriers. The symptoms of typhoid appear 10 to 14 days after infection; they include high fever, rose-colored spots on the abdomen and chest, diarrhea or constipation, and enlargement of the spleen. Complications, especially in untreated patients, may be numerous, affecting practically every body system, and they account for the mortality rate of 7% to 14%. Perforation of the intestine with hemorrhage is not uncommon.
Chloramphenicol was previously the preferred treatment for typhoid, but side effects associated with the drug and increased drug resistance have led to the use of the antibiotics ciprofloxacin and, for pregnant women and some children, ceftriaxone. Antibiotic resistance, however, is an increasing problem in treating typhoid fever, particularly in developing countries. Skilled nursing care is still of the utmost importance, as is drinking fluids to combat dehydration and fever and consuming a high caloric diet to prevent wasting of the body. Vaccination against typhoid is a valuable preventive measure, especially for persons in military service and for those who live in or travel to poorly sanitized regions.
an acute infectious disease of man characterized by fever, intoxication, and lesions of the cardiovascular, nervous, and digestive systems (formation of ulcers in the intestinal wall). Typhoid fever was first described by the French physicians P. Bretonneau (1813) and C. Louis (1829). Typhoid fever is a universal infectious disease prevalent in countries with poor sanitary conditions. Only sporadic cases occur in the USSR. The disease is caused by typhoid bacteria discovered by the German scientist K. Eberth in 1880. This disease affects only man. An infected person (patient or bacteria carrier) excretes typhoid bacteria into the environment in the feces and urine. Infection occurs when the bacteria enter the mouth from the contaminated hands of a sick person or bacteria carrier. The bacteria multiply in milk, water, vegetables, and fruit. Flies may play a role in transmitting the bacteria. After entering the body, the causative agent penetrates into the lymphatic structures of the small intestine (Peyer’s patches), where deep ulcers form seven to ten days after onset of the disease. The bacteria reach the bloodstream via the lymphatic vessels and circulate there from the onset of the disease and throughout the febrile period. Some of the bacteria die in the blood and thereby release a bacterial poison (toxin) that produces pathological disturbances in the body. A significant number of bacteria penetrate into various tissues and organs—the liver, spleen, and bone marrow—where they bring about the changes characteristic of typhoid fever. The disease sets in gradually. After an incubation (latent) period of from ten to 14 days, the patient begins to feel ill, his temperature gradually rises, and insomnia and loss of appetite develop. By the fourth or fifth day of the disease the symptoms become quite pronounced. Headaches, weakness, and apathy become more intensified. The skin, especially on the face, becomes very pale. The tongue is coated with a gray fur. There is distension of the abdomen, as well as hepatic and splenic enlargement. Intoxication subsequently increases. By the eighth to tenth day isolated rose spots about 2 to 3 mm in diameter (the so-called roseolas) appear on the abdomen and sometimes on other parts of the body. At the end of the third week complications may arise in the form of intestinal hemorrhage, perforation of an intestinal ulcer, inflammation of the lungs, bronchitis, and thrombophlebitis. The disease lasts from three to six weeks. The administration of antibiotics has shortened the duration of the disease and sharply reduced the number of deaths. Some patients (about 10 percent) experience relapses.
Typhoid fever is diagnosed on the basis of clinical and epidemiological data. To confirm the diagnosis during the febrile period, a blood culture is taken in order to detect typhoid bacteria. Widal’s agglutination test is taken repeatedly between the eighth and tenth days of the disease.
Typhoid patients must be hospitalized and confined to bed. Treatment consists of a special bland diet, antibiotics, and systemic restorative and symptomatic drugs. Prophylactic measures include observance of the rules of personal hygiene; compliance with sanitary and hygienic requirements, especially in food industry enterprises, grocery stores, dining rooms, restaurants, and snack bars; control of water-supply sources; extermination of flies; isolation of patients; and detection of bacteria carriers and their removal from work in which they may handle food. An auxiliary measure is the vaccination of the population when there are indications of an impending epidemic.
REFERENCERukovodstvo po infektsionnym bolezniam. Edited by A. F. Bilibin and G. P. Rudnev. Moscow, 1962.
K. V. BUNIN