Typhoid fever is a contagious infection of the intestines that affects the whole body. It is caused by a bacterium called Salmonella typhi that is found in the fecal matter of infected individuals. Drinking water can become contaminated with fecal matter from sewage. Typhoid is spread when a person drinks or eats food and water contaminated by human waste (stool or urine) containing Salmonella typhi bacteria.
Typhoid fever is characterized by the sudden onset of a fever, severe headache, nausea, and severe loss of appetite. It is sometimes accompanied by hoarse cough and constipation or diarrhea. Death rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy.
Paratyphoid fever is an infection caused by Salmonella paratyphi. Paratyphoid fever shows similar symptoms, but tends to be milder and the case-fatality rate is much lower. Paratyphoid fever is a serious contagious disease that is also grouped together with typhoid fever under the name enteric fever.
In developing countries, typhoid often occurs in epidemics (many people get sick at once). Most people in the United States get typhoid as a result of visiting another country, such as in India and Brazil, where the food or water supply has been contaminated.
A person may become a carrier of typhoid fever, suffering no symptoms, but capable of infecting others. Carriers must be extra careful with their personal hygiene. They should not work in restaurants or places where food is handled until a healthcare provider determines that they are no longer carriers of the bacteria.
Typhoid fever remains a serious public health problem throughout the world. It is estimated that there are 16-33 million cases and 500,000-600,000 deaths annually. In virtually all areas that suffer from typhoid outbreaks, typhoid fever occurs most often in children from five to 19 years old. The disease is almost exclusively transmitted by food and water contaminated by the feces and urine of patients and carriers. Developing countries with poor sanitation and sewage treatment are especially vulnerable to typhoid outbreaks. Polluted water is the most common source of typhoid transmission. In addition, shellfish taken from sewage-contaminated beds, vegetables fertilized with human excrement and eaten raw, as well as contaminated milk and milk products have been shown to be a source of infection. Typhoid fever has been virtually eliminated in most areas of the industrialized world with the development of proper sanitary facilities. Individuals can transmit the disease as long as the bacteria remain in their body; most people are infectious prior to and during the first week of bed rest, but 10% of untreated patients will still have bacteria present in the body for up to three months. In addition, 2-5% of untreated patients will become permanent, lifelong carriers of the bacteria in their gall-bladder.
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