Typhoid fever

Background

Diagnosed in 2% of febrile travelers

Caused by Salmonella enterica serotype Typhi (formerly Salmonella typhi) serotype paratyphi A, B, and C

Endemic in Mexico, Indonesia, Peru, and the Indian subcontinent

Prior vaccination does not exclude infection

Incubation period 1-3 weeks

Chronic carrier state defined as organism in urine or stool > 12 months

Chronic carrier state risk factors: biliary tract abnormalities

Diagnosis

1. fvr, ha
2. abd pain, constipation, -diarrhea rare
3. leukopenia, thrombocytopenia, dry cough, LN
4. insidious onset unlike dengue or rickettsia
5. dx by blood cx for salmonella enterica serotype typhi
6. serology unreliable

Differential Diagnosis

Fever in traveler

• Normal causes of acute fever!
• Malaria
• Dengue
• Leptospirosis
• Typhoid fever
• Typhus
• Viral hemorrhagic fevers
  • Ebola virus disease
  • Marburg virus disease
  • Lassa fever
  • Crimean-Congo hemorrhagic fever
• Chikungunya
• Yellow fever
• Rift valley fever
• Q fever
• Amebiasis
• Zika virus

Treatment

1. tx empirically with flouroquinolone or 3rd gen cephal
2. vaccine partially effecive and breakthrough infc possible

See Also

Travel Medicine