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  • ASK THE DOCTOR : Typhoid Fever

    Q: A friend of mine came back from South America with a scary story about getting typhoid fever and almost dying! What is the chance of dying from it?

    A: A bacteria called Salmonella typhi causes typhoid fever. Worldwide, the CDC reports 16 million cases and 600,000 deaths. People with typhoid have fevers that peak at 103º to 104ºF (39º to 40ºC). Their heart rates are slower than normal for those at the body temperature. Rose sports may develop on their skin. Many report headache, malaise, stomach pains, and anorexia. Complications – perforated intestines, pneumonia, and severe infection of the heart or brain – cause death. The overall death rate for typhoid patents has been reported as high as 12-32% in the developing world, but less than 2% in industrialized countries.

    Q: How do you get typhoid? What should I avoid while traveling? .

    A: Typhoid fever has been around since the 1870s. it is transmitted when bacteria from human feces gets into food and water. This can happen when untreated waste or sewage water is unwittingly used as a source of water for bathing or cleaning vegetables. Anytime someone else prepares your food in a developing country, there is a possibility of contamination. Chronic carriers shed Salmonella typhi in their stools for over a year after they have been “cured” of typhoid fever and could pass on bacteria if they handle your food. The more widespread typhoid fever is in an area, the more likely you are to ingest contaminated food or water. Avoid risky foods and drinks – follow the rule of “boil it, cook it, peel it or forget it.” Also, avoid antacid medications for ingestion – your body’s first line of defense is stomach acid, which kills bacteria.

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    Q: How long does it take to develop typhoid fever?

    A: After exposure, it usually takes 10 to 14 days to develop symptoms. This depends on the amount of bacteria you ingest. If you ingest a large amount of the bacteria, the incubation period may be only 6 days. Conversely, you can develop symptoms as long as 50 days after ingestion if you consumed very small amounts of Salmonella typhi. Some people have mild cases of typhoid and don’t have any symptoms.

    Q: Should I get a typhoid fever vaccine before my next trip to South America?

    A: Unless you’re planning to travel first-class throughout South America (highly unlikely if you’re a member of the South American Explorers club!), get vaccinated. There are two kinds of injectable vaccines. One has two doses given 4 weeks apart: a booster is given every 3 years. The other is a single dose that requires a booster every 2 years. With the oral vaccine, you take one capsule every 2 days for a total of 4 doses, and you’ll need a booster every 5 years. Make sure you get vaccinated well before your departure date – it may take up to 2 weeks to develop immunity. The effectiveness of the vaccine is about 70%.

    Q: Can you tell if you have typhoid fever from fever patterns?

    A: Fevers typically increase slowly over several days, peaks at 103º to 104ºF (39º to 40ºC), remains constant for 2 to 3 weeks, and then subsides. With the right antibiotics, the fever may disappear in 3 to 4 days. Many clinicians try to use fever patterns to diagnose typhoid fever, but the most effective method is using tissue cultures. Blood cultures identify Salmonella typhi up to 80 percent of the time, and bone marrow cultures have a 90 percent success rate.

    Q: If I get a fever while I’m traveling in South America, and I think I’ve got typhoid, what should I do?

    A: Seek local medical care immediately. Call the US Consulate for a list of recommended doctors. Local doctors will be familiar with the disease and can perform blood culture tests early on.

    Q: How is typhoid fever treated?

    A: The antibiotics chloramphenicol, ampicillin, and trimethoprimsulfamethoxazole have been traditional treatments. Because of resistance to these antibiotics, newer drugs (ciprofloxicin or ceftiaxone) are preferred. You can find out from blood culture what antibiotics the strain of Salmonella typhi are resistant to. Interested in reading more? See the Centers for Disease Control web page.