Snapshot A 33-year-old international aid worker reports the onset of fever, diarrhea and a rash that started shortly after his return from an oversees mission trip. Introduction Typhoid fever is a systemic, flu-like bacterial infection resulting in diarrhea and rash Caused by infection with Salmonella typhi via contaminated food, drink, and water sources Life cycle bacteria enter the bloodstream (bacteremia) via the intestines rapidly spreads to other organs including lymph nodes gall bladder liver spleen bacteria multiply in Peyer's Patches at end-organs continue to spread via defication in carrier stool Epidemiology less than 400 cases per year occur in the United States (usually immigration cases) more common in the developing world Presentation Symptoms onset is generally slow and presents with fever and chills constipation myalgias delirium attention deficit agitatation bloody stools fatigue or lethargy fever >103 F plus frequent diarrhea are indicative of severe disease Physical exam abdominal tenderness splenomegaly Rose spots or red macules on abdomen occur in 30% of cases delirium fluctuating mood hallucinations muscle weaknessclassic pulse-fever dissociation high fever and low pulse (also seen in brucellosis) Evaluation CBC high WBC, low platelets Blood culture shows S. typhi within one week of infection sensitivity may be critical for directing treatment, given high rates of resistence Urine ELISA and fluorescent antibody may aid in identifying bacteria Stool culture may grow S. typhi Differential Other bacterial or viral rashes Treatment Non-operative IV fluids and electrolytes indicated for resuscitation in all cases IV antibiotics indicated as first-line therapy to treat infection ceftriaxone, or other medications based on sensitivity Operative cholecystectomy may be indicated for chronic, asmptomatic fevers S. typhi resides in gallbladder Prognosis, Prevention, and Complications Prognosis good with early identification and treatment; poor if delayed or unnoticed disease starts to resolve around week 3 with appropriate treatment Prevention vaccinations/immunization water treatment Complications patients may become chronic carriers due to gall bladder infection other major complications include intestinal hemorrhage intestinal perforation kidney failure peritonitis