see also: [typhoid fever in children - pediatric EM morsels](https://pedemmorsels.com/typhoid-fever-in-children/), [Typhoid - Hayes’](x-devonthink-item://939F21D1-F059-45DF-A49F-D3573B163B8C) > Typhoid fever is systemic bacterial illness characterized by abdominal pain and fever caused by the **gram-negative**, flagellated, rod-shaped bacteria Salmonella enterica serotype Typhi. Paratyphoid, a similar illness, is caused by S. enterica serotype Paratyphi A, B, or C. *Salmonella Typhi*, also from salmonella paratyphi **prevention:** Oral and intramuscular (IM) typhoid vaccines are available in the U.S. for travelers to endemic areas. **Mechanism** - infaves small bowel via peyer's patches → spread to lymphnodes → enter blood Humans are only host S. typhii is spread human to human, often from water sources or chronic carriers. The other Salmonella are commonly found in eggs, chickens, turkeys, frogs, turtles, reptiles. Outbreaks from handling animal meat and tomatoes. **Incubation**: 6-30 days # signs and symptoms - Typhoid classically goes through several phases, each lasting about a week. - *week 1*: progressive fever, chills, malaise, relative bradycardia, headache, and cough. - *week 2:* severe fatigue, abdominal pain, delirium, and a characteristic rash consisting of **salmon-colored “rose spots” appear on the chest and abdomen**. Constipation or diarrhea can also occur, as well as hepatosplenomegaly. - *week 3:* severe complications such as encephalitis and GI hemorrhage or **perforation** can occur. - Convalescence typically begins after the third week of illness and it may take several months for the patient to fully recover. # diagnosis Culture and serological testing. Cultures can be obtained from blood, stool, duodenal aspirates, vomitus, rose spots, and bone marrow. Multiple sets of blood cultures increase the likelihood of detection. # treatment - **Ciprofloxacin** or levofloxacin can be used for treatment of cases of typhoid fever that were not acquired in Asia. - Given increasing resistances to fluoroquinolones in Asia, **ceftriaxone** or **azithromycin** should be used for infections linked to that region. - Azithromycin can be used in children. - **Dexamethasone** is indicated as an adjunct in cases of severe infection. # Related Questions ## typhoid - [ ] 1Q: [Typhoid](x-devonthink-item://1A2C485F-D4AD-4821-AFF2-452BA753717F?page=32) -- [Answer](x-devonthink-item://FD716379-1A77-4B5B-B257-1154995ECA6E?page=20)