Salmonella Typhi lives only in humans. In persons with typhoid fever the bacteria initially enter through the intestinal tract and eventually invade the bloodstream. The resulting illness is often non-specific and clinically non-distinguishable from other febrile illnesses. Symptoms include:
prolonged high fever
fatigue
headache
nausea
abdominal pain
constipation or diarrhoea
rash, in some cases.
Severe cases may lead to serious complications or even death.
Typhoid fever can be treated with antibiotics. As resistance to antibiotics has emerged including to fluoroquinolones, newer antibiotics such as cephalosporins and azithromycin are used in the affected regions. However, increasing resistance to cephalosporins has been reported, including the emergence in 2017 of an extensively drug resistant strain of Salmonella Typhi. Resistance to azithromycin has been reported sporadically.
Even when the symptoms go away, approximately 2-5% of cases can go on to become chronic carriers and contribute to the spread of typhoid through ongoing faecal shedding of the bacteria and contamination of water and food. It is important for people being treated for typhoid fever to do the following:
Take prescribed antibiotics for as long as the doctor has prescribed.
Wash their hands with soap and water after using the bathroom, and avoid preparing or serving food to other people. This will lower the chance of passing the infection on to someone else.
Have their doctor test (after the antibiotic course) to ensure that no Salmonella Typhi bacteria remain in their body.
Typhoid fever
Typhoid fever is a life-threatening systemic infection caused by the bacterium Salmonella enterica serovar Typhi (commonly known as Salmonella Typhi). Typhoid is usually spread through the ingestion of contaminated food or water.
Typhoid occurs predominantly in association with poor sanitation and lack of clean drinking water, in both urban and rural settings. However, urbanization, with associated overcrowded populations and inadequate water and sanitation systems, as well as climate change have the potential to further increase the global burden of typhoid. In addition, increasing antibiotic resistance is making it easier for typhoid to spread and be treated.
Every year, an estimated 11–20 million people get sick from typhoid and between 128 000 and 161 000 people die from it worldwide. Poor communities and vulnerable groups including children are at highest risk.
Travellers are at risk of developing typhoid fever in many typhoid endemic countries, particularly in Asia and sub-Saharan Africa. Elsewhere, travellers are usually at risk when exposed to low standards of personal hygiene or food hygiene and poor water quality.
Even vaccinated travellers should take care to avoid consumption of potentially contaminated food and water as vaccination does not confer 100% protection.
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