infectious diseases
Typhoid Fever
Key Points
Typhoid fever is spread enterically and causes fever and other constitutional symptoms (eg, headache, arthralgia, anorexia, abdominal pain and tenderness); later in the disease, some patients develop severe, sometimes bloody diarrhea and/or a characteristic rash (rose spots). Bacteremia occasionally causes focal infections (eg, pneumonia, osteomyelitis, endocarditis, meningitis, soft-tissue abscesses, glomerulitis). A chronic carrier state develops in about 3% of untreated patients; they harbor organisms in their gallbladder and shed them in stool for>1 year. Diagnose using blood and stool cultures; because drug resistance is common, susceptibility testing is essential. Treat withceftriaxone, a fluoroquinolone, orazithromycin, guided by susceptibility testing; corticosteroids may be given to decrease severe symptoms. Give carriers a prolonged course of antibiotics; sometimes cholecystectomy is necessary. Patients must be reported to the local health department and prohibited from handling food until they are proved free of the organism. Vaccination may be appropriate for certain travelers to endemic regions. 