is also known as Enteric fever. It is an infection caused by a bacteria
called as the salmonella bacillus. Salmonella typhi causes typhoid fever
and Salmonella paratyphi A & B cause paratyphoid fever.
Mode of Infection
Humans are the only natural reservoirs of S. typhi. Ingestion of food
or water contaminated with human faeces is the most common mode of transmission.
The salmonella organisms after ingestion attack the intestine and enter
into the blood stream. These organisms then the bone-marrow, liver,
spleen and other organs. The bacteria again enter the blood from these
organs and again reach the intestine through the bile by local multiplication
in the walls of gall bladder. Circulating endotoxin (a part of the bacterial
cell wall) is thought to be the cause of prolonged fever and toxic symptoms.
Some patients may excrete S. typhi for three months or longer after
infection leading to a chronic carrier state.
Onset: Gradual onset fever, anorexia, malaise, diarrhea in early stages
and then constipation.
2nd week: High fever, toxic child, delirium, enlarged liver and spleen,
diffuse abdominal tenderness. A rash may be seen around 7th to 10th
day on the chest and the abdomen. The fever usually resolves within
2-4 weeks but malaise and lethargy persist for a longer time.
1. Severe intestinal hemorrhage and intestinal perforation - seen usually
in 1st week of illness.
2. Heart involvement in the form of shock and psychosis may also be
3. Rare complications - Hepatitis (inflammation of liver), Cholecystitis
(inflammation of gall bladder), pancreatitis (inflammation of pancreas),
pneumonia, bone marrow involvement, pyelonephritis (inflammation of
Blood tests in the from of Widal test and culture may help in the diagnosis.
In some patients' urine, stool and bone marrow culture may also be positive.
Your doctor will prescribe antibiotics for 7-10 days. In patients with
high fever, intravenous antibiotics may be required. In children with
malnutrition, antibiotic therapy can be extended for 21 days to reduce
the rate of complications.
In patients with shock, obtundation, stupor or coma a short course of
steroids improves the survival.
To eradicate chronic carrier stage: High dose antibiotics for 4-6 weeks
1. Oral Ty21a strain S.typhi - A live attenuated preparation. Recommended
in children more than 6 years of age. Four enteric coated capsules on
alternate days are given.
2. Vi Capsular polysaccharide vaccine - It is given intramuscular in
children less than 2 yrs of age.
Booster is required every 3 yrs.
created on 13-12-2002
updated on 18-11-2006