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An infectious bacterial fever with an eruption of red spots on the chest and abdomen and severe intestinal irritation.

Typhoid fever, also known simply as typhoid, is a symptomatic bacterial infection due to Salmonella typhi. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high fever over several days. Weakness, abdominal pain, constipation, and headaches also commonly occur. Diarrhea and vomiting are uncommon. Some people develop a skin rash with rose colored spots. In severe cases there may be confusion. Without treatment symptoms may last weeks or months. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever along with paratyphoid fever.

The cause is the bacterium Salmonella typhi, also known as Salmonella enterica serotype typhi, growing in the intestines and blood. Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person. Risk factors include poor sanitation and poor hygiene. Those who travel to the developing world are also at risk. Humans are the only animal infected. Diagnosis is by either culturing the bacteria or detecting the bacterium's DNA in the blood, stool, or bone marrow. Culturing the bacterium can be difficult. Bone marrow testing is the most accurate. Symptoms are similar to that of many other infectious diseases. Typhus is a different disease.

A typhoid vaccine can prevent about 50% to 70% of cases. The vaccine may be effective for up to seven years. It is recommended for those at high risk or people traveling to areas where the disease is common. Other efforts to prevent the disease include providing clean drinking water, better sanitation, and better handwashing. Until it has been confirmed that an individual's infection is cleared, the individual should not prepare food for others. Treatment of disease is with antibiotics such as azithromycin, fluoroquinolones or third generation cephalosporins. Resistance to these antibiotics has been developing, which has made treatment of the disease more difficult.

In 2010 there were 27 million cases reported. The disease is most common in India, and children are most commonly affected. Rates of disease decreased in the developed world in the 1940s as a result of improved sanitation and use of antibiotics to treat the disease. About 400 cases are reported and the disease is estimated to occur in about 6,000 people per year in the United States. In 2013 it resulted in about 161,000 deaths – down from 181,000 in 1990 (about 0.3% of the global total). The risk of death may be as high as 25% without treatment, while with treatment it is between 1 and 4%. The name typhoid means "resembling typhus" due to the similarity in symptoms.


In 430 BC, a devastating plague, which some believe to have been typhoid fever, killed one-third of the population of Athens, including their leader Pericles. Following this disaster, the balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the Greek ancient world. The ancient historian Thucydides also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak, and modern academics and medical scientists consider epidemic typhus the most likely cause. In 2006, a study detected DNA sequences similar to those of the bacterium responsible for typhoid fever in dental pulp extracted from a burial pit dated to the time of the outbreak.[38]

The cause of the plague has long been disputed and other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.[39] The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question related to Athens above, the whole population of Attica was besieged within the Long Walls and lived in tents.

Some historians believe that English colony of Jamestown, Virginia, died out from typhoid. Typhoid fever killed more than 6000 settlers in the New World between 1607 and 1624.[40]

During the American Civil War, 81,360 Union soldiers died of typhoid or dysentery, far more than died of battle wounds.[41] In the late 19th century, the typhoid fever mortality rate in Chicago averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 people.[42]

During the Spanish–American War, American troops were exposed to typhoid fever in stateside training camps and overseas, largely due to inadequate sanitation systems. The Surgeon General of the Army, George Miller Sternberg, suggested that the War Department create a Typhoid Fever Board. Major Walter Reed, Edward O. Shakespeare, and Victor C. Vaughan were appointed August 18, 1898, with Reed being designated the President of the Board. The Typhoid Board determined that during the war, more soldiers died from this disease than from yellow fever or from battle wounds. The Board promoted sanitary measures including latrine policy, disinfection, camp relocation, and water sterilization, but by far the most successful antityphoid method was vaccination, which became compulsory in June 1911 for all federal troops.[43]

The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mary. In 1907, she became the first carrier in the United States to be identified and traced. She was a cook in New York who is closely associated with 53 cases and three deaths.[44] Public health authorities told Mary to give up working as a cook or have her gall bladder removed, as she had a chronic infection that kept her active as a carrier of the disease. Mary quit her job, but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.

The disease has been referred to by various names, often associated with symptoms, such as gastric fever, enteric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, and pythogenic fever.

Notable cases:

  • Roger Sherman, one of the Founding Fathers of the United States, died of typhoid fever in 1793.
  • Abigail Adams, wife of Founding Father and President John Adams and mother of the sixth President John Quincy Adams, died of typhoid fever on October 28, 1818, at the age of 73.
  • Prince Albert, husband of Queen Victoria, died of typhoid fever at the age of 42.
  • Gen. Ignacio Zaragoza, general in the Mexican army in charge of the Battle of Puebla on May 5, 1862, died of typhoid fever on September 8, 1862, at the age of 33, shortly after his victory over the French army.
  • Louisa May Alcott, author of Little Women, contracted typhoid while serving as a nurse at a hospital in Washington, D.C. in 1862-1863, but survived.
  • Princess Leopoldina of Brazil, daughter of Emperor Pedro II of Brazil, died of typhoid fever on February 7, 1871, at the age of 23.
  • In memory of Leland Stanford, Jr., who died of typhoid in 1884, his parents founded Stanford University.
  • Gerard Manley Hopkins, English poet, died of typhoid fever in 1889.[52]
  • Major Gonville Bromhead, who fought in the Battle of Rorke's Drift, depicted in the film Zulu, died of typhoid fever in India in 1891.
  • Dr HJH 'Tup' Scott, captain of the 1886 Australian cricket team that toured England, died of typhoid in 1910.[53]
  • Wilbur Wright, the older of the two Wright brothers, died of typhoid on May 30, 1912.
  • Edith Claypole, a British scientist, died of typhoid in 1915. She acquired the disease while preparing vaccinations for WWI troops, despite the protection of having been vaccinated herself.
  • Arnold Bennett, English novelist, died in 1932 of typhoid, two months after drinking a glass of water in a Paris hotel to prove it was safe.[54]
  • Hakaru Hashimoto, Japanese medical scientist, died of typhoid fever in 1934.[55]
  • Louis Napoleon George Filon, former Vice Chancellor of London University 1933–35 died of typhoid fever following a local outbreak in Croydon, South London, in 1937.
  • Huang Tzu, Chinese musician, died of typhoid fever in 1938.
  • Mary Mallon, "Typhoid Mary", developed a chronic infection of her gall bladder and is presumed to have infected 51 people over her career as a cook; she was forced to live in quarantine for years and died of pneumonia in 1938.
  • Heath Bell, a relief pitcher for the San Diego Padres ,acquired typhoid on a 2010 trip to Fiji, but survived.[56

Further reading:

  • Easmon C (2005-04-01). "Typhoid fever and paratyphoid fever". Travel Health. Retrieved 2008-10-05.
  • Harrison NG. "Walter Reed and Typhoid Fever, 1897–1911". Univ of Virginia. Retrieved 2008-10-05.
  • Nicolson, Stuart (2008-06-26). "Typhoid left city (Aberdeen) 'under siege'". BBC News. Retrieved 2008-10-05.
  • O'Hara C (2006-01-26). "Typhoid Fever Led To The Fall Of Athens". Elsevier. Retrieved 2008-10-05.

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