Typhoid

Typhoid
A systemic infection with pronounced gastrointestinal symptoms, caused by infection with
Salmonella typhi (also known as Salmonella enterica serovar typhi). Typhoid is a notifiable
disease.
SPREAD B Y The infection is present in the stools and sometimes in the blood and urine
of an infected person. The commonest mode of spread is faecal–oral, usually through contaminated
water (mainly in the developing world) or by contamination of food. Direct
person-to-person faecal–oral transmission can occur in poor hygiene conditions or in men
who have sex with men.
Household transmission of infection may occur, probably through lapses in food hygiene.
Most cases in the UK are acquired abroad.
I N F E C T I O U S P E R I OD The incubation period is 7–14 days. Patients may remain infectious
for several weeks after infection. Approximately 5% of cases become chronic carriers
who continue to shed bacteria in the stool indefinitely.
I N F E C T I O N C O N T R O L P R E C A U T I O N S
1 Isolation Required
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Not required unless there is a significant
risk of splashing to the face
6 Eye protection Not required
S TA F F No additional precautions.
VI S I T O R S Visitors should be reminded not to eat or drink in the patient’s room. They
should wear PPE as above and should wash their hands when leaving the isolation room.
PAT I E N T T R A N S F E R Patient transfer should only occur if necessary and the receiving
ward/department must be informed of the diagnosis.
MORE INFORMAT I O N Infection with typhoid or paratyphoid is known as enteric fever.
Clinical features of typhoid include fever of 39–40 °C, myalgia, abdominal pain and severe
headache. Some patients have a rash on the trunk known as ‘rose spots’. Diarrhoea is
present in less than half of patients. Typhoid is a serious illness, with 20% mortality if
untreated due to intestinal perforation or haemorrhage. Even when treated it may take
several days to respond, with resolution of fever over 2–5 days and convalescence over
several weeks.
The choice of antibiotic depends on sensitivity test results, as resistance is becoming
increasingly common. The drug of choice is ciprofloxacin but alternatives include ceftriaxone
and azithromycin.
Diagnosis is usually by stool sample, but blood or urine culture may also be positive.
Serology is rarely useful.
Typhoid patients who are at high risk of passing it on, such as food handlers, should be
screened for clearance by stool sample analysis on the advice of public or environmental

health. The famous ‘Typhoid Mary’ was a cook and typhoid carrier in the early twentieth
century who caused numerous outbreaks of typhoid!
Preventative measures include pre-travel hygiene advice and vaccination. Vaccination is
not recommended for contacts of cases as it has not been shown to be effective in these
circumstances.