Typhoid Fever

Excerpt

Typhoid fever and paratyphoid fever are clinically indistinguishable febrile multisystemic illnesses caused by Salmonella enterica serotypes Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C. Collectively known as enteric fever, more than 9 million people are sickened, and 110,000 die from the disease every year around the globe.[WHO. Typhoid Fact Sheet. 2023] Enteric fever is the leading cause of community-acquired bloodstream infections in South and Southeast Asia. A reportable disease in the United States and many other developed nations, enteric fever is second only to malaria as a cause of severe and sometimes life-threatening infection in travelers.[2]

Following an incubation period of 6 to 30 days, enteric fever presents insidiously with the gradual onset of fever with fatigue, anorexia, headache, malaise, and abdominal symptoms. If treatment is delayed or inadequate, meningitis, sepsis, or intestinal perforation can occur. With a history of S Typhi and S Paratyphi strains rapidly developing antimicrobial resistance with the widespread use of successive antibiotics, the recent emergence of extensively drug-resistant strains has greatly complicated treatment and raised alarms.

S Typhi and S Paratyphi are said to spread by the "4 Fs" (flies, fingers, feces, and fomites). They afflict people living or traveling in low- and middle-income countries around the globe that lack clean water, adequate sanitation, and hygiene, known collectively as WASH. Improved WASH infrastructure is the foundation for decreasing the incidence of enteric fever and other diseases spread via the fecal-oral route.

Historically, enteric fever has received less investment and attention than the "big 3" (human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and malaria). However, with the specter of untreatable variants on the horizon, enteric fever control efforts have been renewed. Recently developed typhoid conjugate vaccines, improved surveillance and understanding of antimicrobial resistance patterns, and WASH initiatives have decreased the disease burden.

This activity covers the epidemiology, pathophysiology, treatment, management, complications, patient education, prevention measures, and the role of the interprofessional team in improving patient care and decreasing the burden of this disease. While several barriers to controlling this disease exist, recent advancements provide hope that the impact of enteric fevers can be limited or eliminated in the future.