Ver el código de «Typhoid fever»

''Not to be confused with [[typhus]], a distinct disease caused by a different genera of bacteria''
==Background==
[[File:Mm7207a2-F-large.gif|thumb|Estimated national typhoid fever incidence* and typhoid conjugate vaccine introduction† status — worldwide, 2019 and 2022. TCV = typhoid conjugate vaccine. Cases per 100,000 population. † Liberia, Nepal, Pakistan, Samoa, and Zimbabwe have introduced TCV.<ref>Global Burden of Disease Collaborative Network, Global Burden of Disease study, 2019. https://www.healthdata.org/gbd/gbd-2019-resources</ref>]]
*Also known as "enteric fever" (of which paratyphoid fever is an additional subset) 
*Diagnosed in 2% of febrile travelers and caused by ''[[Salmonella]] enterica serotype Typhi'' (formerly ''Salmonella typhi'') ''serotype paratyphi A, B, and C''<ref>Tintinalli et. al. Typhoid Fever. In: Tintinalli et. al. Emergency Medicine A Comprehensive Study Guide. New York, NY: McGraw Hill. 2011. 1082-1084. </ref>
*Endemic in Mexico, Indonesia, Peru, and the Indian subcontinent
*Prior vaccination does not exclude infection
*Incubation period 1-3 weeks with chronic carrier state defined as organism in urine or stool > 12 months
*Chronic carrier state risk factors: biliary tract abnormalities<ref>Hohmann, E. Epidemiology, microbiology, clinical manifestations, and diagnosis of typhoid fever . In: UpToDate. Last updated: July 2013. Accessed July 30, 2014.</ref>

==Clinical Features==
[[File:Typhoid patient.png|thumb|Typical clinical features in patient suffering from typhoid.]]
[[File:Salmonella typhi typhoid fever PHIL 2215 lores.jpg|thumb|Rose spots (flat, rose-colored spots) on the chest of a patient with typhoid fever.]]
[[File:Typhoid Stool.jpg|thumb|Example of frank bloody "pea soup" diarrhea characteristic during the second week.]]
===Classic symptoms===
*[[Bradycardia]] relative to fever (Faget sign)

===Initial symptoms===
*[[Fever]]
*[[Abdominal Pain]]
*[[Headache]]

===Subsequent symptoms===
*Chills (rarely rigors)
*Cough
*Abdominal distension
*Constipation (more common than diarrhea)
*“Rose spots” – truncal light red macular rash (in the 2nd wk)
*Hepatosplenomegaly
*GI bleeding
*Transaminitis
*Leukopenia with left shift (adults)
*Leukocytosis (children)

==Differential Diagnosis==
*Viral hepatitis
*Amebic Liver Abscess
*Infectious enteritis

{{Template:Fever in Traveler DDX}}

==Evaluation==
[[File:Microscopic Typhoid Fever.jpg|thumb|Bacilli of typhoid fever from a culture. The long flagellae, which are constantly in motion, are very charatteristic of this organism.]]
*Blood culture
*Urine culture
*Stool culture
*“Rose spot” aspiration
*Bone marrow culture (most sensitive)
*Sensitivity testing for nalidixic acid

==Management==
*Consultation with Infectious Disease should be considered since there are increasingly multidrug resistant strains of S. Typhi and coinfection with diseases such as [[Malaria]] may complicate treatment.  The therapy favors the use of fluorquinolones unless suspected or known resistance.<ref>Bhutta ZA. et al. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul 8;333(7558):78-82. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489205/pdf/bmj33300078.pdf PDF]</ref>
===Antibiotics===
{{Typhoid Antibiotics}}

===Adjunctive Therapy===
*If associated delirium, coma, shock, and/or [[DIC]]: Dexamethasone 3mg/kg IV load over 30 minutes, then 1mg/kg IV every 6 hours x 8 doses

==Disposition==
*Admit if any complication

==Complications==
*Small-bowel ulceration
*Intestinal perforation
*[[Anemia]]
*[[DIC]]
*[[Pneumonia]]
*[[Meningitis]]
*[[Myocarditis]]
*[[Cholecystitis]]
*[[Renal Failure]]
*Chronic carrier state

==References==
<references/>

==See Also==
*[[Travel Medicine]]
*[[Fever in Traveler]]

[[Category:ID]]
[[Category:Tropical Medicine]]