Typhoid fever

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Typhoid fever
Other namesSlow fever, typhoid
Salmonella typhi typhoid fever PHIL 2215 lores.jpg
Rose spots on the chest of a person with typhoid fever
Specialty Infectious disease
SymptomsFever, abdominal pain, headache, rash [1]
Usual onset6–30 days after exposure [1] [2]
Causes Salmonella enterica subsp. enterica (spread by food or water contaminated with feces) [3] [4]
Risk factors Poor sanitation, poor hygiene. [3]
Diagnostic method Bacterial culture, DNA detection [2] [3] [5]
Differential diagnosis Other infectious diseases [6]
Prevention Typhoid vaccine, handwashing [2] [7]
Treatment Antibiotics [3]
Frequency12.5 million (2015) [8]
Deaths149,000 (2015) [9]

Typhoid fever, also known simply as typhoid, is a bacterial infection due to specific type of Salmonella that causes symptoms. [3] Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. [1] [2] Often there is a gradual onset of a high fever over several days. [1] This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting. [2] [6] Some people develop a skin rash with rose colored spots. [2] In severe cases people may experience confusion. [6] Without treatment, symptoms may last weeks or months. [2] Diarrhea is uncommon. [6] Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. [4] Typhoid fever is a type of enteric fever, along with paratyphoid fever. [3]

<i>Salmonella</i> Genus of prokaryotes

Salmonella is a genus of rod-shaped (bacillus) Gram-negative bacteria of the family Enterobacteriaceae. The two species of Salmonella are Salmonella enterica and Salmonella bongori. S. enterica is the type species and is further divided into six subspecies that include over 2,600 serotypes.

Fever common medical sign characterized by elevated body temperature

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Abdominal pain Stomach aches

Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.


The cause is the bacterium Salmonella enterica subsp. enterica growing in the intestines and blood. [2] [6] Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person. [4] Risk factors include poor sanitation and poor hygiene. [3] Those who travel in the developing world are also at risk. [6] Only humans can be infected. [4] Symptoms are similar to those of many other infectious diseases. [6] Diagnosis is by either culturing the bacteria or detecting the bacterium's DNA in the blood, stool, or bone marrow. [2] [3] [5] Culturing the bacterium can be difficult. [10] Bone marrow testing is the most accurate. [5]

Blood specialized bodily fluid in animals

Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells.

Feces solid or semisolid remains of the food that could not be digested in the small intestine

Feces, colloquially known as poop, are the solid or semisolid remains of the food that could not be digested in the small intestine. Bacteria in the large intestine further break down the material. Feces contain a relatively small amount of metabolic waste products such as bacterially altered bilirubin, and the dead epithelial cells from the lining of the gut.

Sanitation public health conditions related to clean drinking water and adequate disposal of human excreta and sewage

Sanitation refers to public health conditions related to clean drinking water and adequate treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems aim to protect human health by providing a clean environment that will stop the transmission of disease, especially through the fecal–oral route. For example, diarrhea, a main cause of malnutrition and stunted growth in children, can be reduced through sanitation. There are many other diseases which are easily transmitted in communities that have low levels of sanitation, such as ascariasis, cholera, hepatitis, polio, schistosomiasis, trachoma, to name just a few.

A typhoid vaccine can prevent about 40% to 90% of cases during the first two years. [7] The vaccine may have some effect for up to seven years. [3] It is recommended for those at high risk or people traveling to areas where the disease is common. [4] Other efforts to prevent the disease include providing clean drinking water, good sanitation, and handwashing. [2] [4] Until it has been confirmed that an individual's infection is cleared, the individual should not prepare food for others. [2] The disease is treated with antibiotics such as azithromycin, fluoroquinolones or third generation cephalosporins. [3] Resistance to these antibiotics has been developing, which has made treatment of the disease more difficult. [3] [11]

Typhoid vaccines are vaccines that prevent typhoid fever. Several types are widely available: typhoid conjugate vaccine (TCV), Ty21a and Vi capsular polysaccharide vaccine (ViPS). They are about 30 to 70% effective for the first two years depending on the specific vaccine in question. The Vi-rEPA vaccine has been shown to be efficacious in children.

Drinking water water safe for consumption

Drinking water, also known as potable water, is water that is safe to drink or to use for food preparation. The amount of drinking water required varies. It depends on physical activity, age, health issues, and environmental conditions. Americans, on average, drink one litre of water a day and 95% drink less than three litres per day. For those who work in a hot climate, up to 16 litres a day may be required. Water is essential for life.

Antibiotic drug used in the treatment and prevention of bacterial infections

An antibiotic is a type of antimicrobial substance active against bacteria and is the most important type of antibacterial agent for fighting bacterial infections. Antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics.

In 2015, there were 12.5 million new cases worldwide. [8] The disease is most common in India. [3] Children are most commonly affected. [3] [4] 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. [4] Each year in the United States, about 400 cases are reported and it is estimated that the disease occurs in about 6,000 people. [6] [12] In 2015, it resulted in about 149,000 deaths worldwide – down from 181,000 in 1990 (about 0.3% of the global total). [9] [13] The risk of death may be as high as 20% without treatment. [4] With treatment, it is between 1 and 4%. [3] [4] Typhus is a different disease. [14] However, the name typhoid means "resembling typhus" due to the similarity in symptoms. [15]

Typhus group of infectious diseases

Typhus, also known as typhus fever, is a group of infectious diseases that include epidemic typhus, scrub typhus and murine typhus. Common symptoms include fever, headache, and a rash. Typically these begin one to two weeks after exposure.

Video summary (script)

Signs and symptoms

Rose spots on chest of a person with typhoid fever PHIL 2214.tif
Rose spots on chest of a person with typhoid fever

Classically, the progression of untreated typhoid fever is divided into four distinct stages, each lasting about a week. Over the course of these stages, the patient becomes exhausted and emaciated. [16]

Bradycardia Heart rate that is below the normal range

Bradycardia is a condition typically defined wherein an individual has a resting heart rate of under 60 beats per minute (BPM) in adults. Bradycardia typically does not cause symptoms until the rate drops below 50 BPM. When symptomatic, it may cause fatigue, weakness, dizziness, sweating, and at very low rates, fainting.

In medicine, the Faget sign — sometimes called sphygmothermic dissociation — is the unusual pairing of fever with bradycardia. The Faget sign is named after Louisiana physician Jean Charles Faget, who studied yellow fever in Louisiana.

Malaise is a feeling of general discomfort, uneasiness, or pain, often the first sign of an infection or other disease. The word has existed in the French language since at least the 12th century.


A 1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a water well (center) ForskeligeVeje ad hvilkenBroen kan inficeres medTyfusbaciller.png
A 1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a water well (center)


The Gram-negative bacterium that causes typhoid fever is 'Salmonella enterica subsp. enterica. [18] There are two main types of the subsp. enterica, namely the ST1 and ST2, based on MLST subtyping scheme, which are currently widespread globally. [19]


Salmonella enterica subsp. enterica is spread through the fecal-oral route from individuals that are currently infected and from asymptomatic carriers of the bacteria. [20] Unlike other strains of Salmonella , there are no animal carriers of S. e. subsp. enterica. [20] Humans are the only known carriers of the bacteria. [20] An asymptomatic human carrier is an individual who is still excreting S. e subsp. enterica in their stool a year after the acute stage of the infection. [20] Human carriers are responsible for the transmission of the bacteria in endemic regions of the world. [20]


Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test (demonstration of antibodies against Salmonella antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentery, or pneumonia, a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of the Widal test and cultures of the blood and stool. [21]

The Widal test is time-consuming and prone to significant false positive results. The test may also be falsely negative in the early course of illness. However, unlike the Typhidot test, the Widal test quantifies the specimen with titres.

Typhidot is a medical test consisting of a dot ELISA kit that detects IgM and IgG antibodies against the outer membrane protein (OMP) of the Salmonella enterica subsp. enterica. The typhidot test becomes positive within 2–3 days of infection and separately identifies IgM and IgG antibodies. The test is based on the presence of specific IgM and IgG antibodies to a specific 50Kd OMP antigen, which is impregnated on nitrocellulose strips. IgM shows recent infection whereas IgG signifies remote infection. The most important limitation of this test is that it is not quantitative and the result is only positive or negative.

The term 'enteric fever' is a collective term that refers to severe typhoid and paratyphoid. [22]


Doctor administering a typhoid vaccination at a school in San Augustine County, Texas, 1943 Typhoid inoculation2.jpg
Doctor administering a typhoid vaccination at a school in San Augustine County, Texas, 1943

Sanitation and hygiene are important to prevent typhoid. Typhoid does not affect animals other than humans. Typhoid can only spread in environments where human feces are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to prevent typhoid. Industrialization, and in particular, the invention of the automobile, contributed greatly to the elimination of typhoid fever, as it eliminated the public health hazards associated with having horse manure in the public street which led to large number of flies [23] which are known as vectors of many pathogens including Salmonellae. [24] According to statistics from the United States Centers for Disease Control and Prevention (CDC), the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the United States. [ citation needed ]


Two typhoid vaccines are licensed for use for the prevention of typhoid: [7] the live, oral Ty21a vaccine (sold as Vivotif by Crucell Switzerland AG) and the injectable typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and 'Typherix by GlaxoSmithKline). Both are efficacious and recommended for travellers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form. [25] [ needs update ] An older, killed-whole-cell vaccine is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection). [26]

To help decrease rates of typhoid fever in developing nations, the World Health Organization (WHO) endorsed the use of a vaccination program starting in 1999. Vaccinations have proven to be a great way at controlling outbreaks in high incidence areas. Just as important, it is also very cost-effective. Vaccination prices are normally low, less than US $1 per dose. Because the price is low, poverty-stricken communities are more willing to take advantage of the vaccinations. [27] Although vaccination programs for typhoid have proven to be effective, they alone cannot eliminate typhoid fever. [27] Combining the use of vaccines along with increasing public health efforts is the only proven way to control this disease. [27]

Since the 1990s there have been two typhoid fever vaccines recommended by the World Health Organization. The ViPS vaccine is given via injection, while the Ty21a is taken through capsules. It is recommended only people 2 years or older be vaccinated with the ViPS vaccine and requires a revaccination after 2–3 years with a 55–72% vaccine efficacy. The alternative Ty21a vaccine is recommended for people 5 years or older, and has a 5-7-year duration with a 51–67% vaccine efficacy. The two different vaccines have been proven as a safe and effective treatment for epidemic disease control in multiple regions. [28]

A version combined with hepatitis A is also available. [29]


Oral rehydration therapy

The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general.


Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin. [22] [30] Otherwise, a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice. [31] [32] [33] [34] Cefixime is a suitable oral alternative. [35] [36]

Typhoid fever, when properly treated, is not fatal in most cases. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, amoxicillin, and ciprofloxacin, have been commonly used to treat typhoid fever in microbiology. [37] Treatment of the disease with antibiotics reduces the case-fatality rate to about 1%. [38]

Without treatment, some patients develop sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms and, occasionally, pneumonia. In white-skinned patients, pink spots, which fade on pressure, appear on the skin of the trunk in up to 20% of cases. In the third week, untreated cases may develop gastrointestinal and cerebral complications, which may prove fatal in up to 10–20% of cases. The highest case fatality rates are reported in children under 4 years. Around 2–5% of those who contract typhoid fever become chronic carriers, as bacteria persist in the biliary tract after symptoms have resolved. [39]


Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations.

If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.


As resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and streptomycin is now common, these agents have not been used as first–line treatment of typhoid fever for almost 20 years.[ citation needed ] Typhoid resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent and Southeast Asia. Many centres are shifting from using ciprofloxacin as the first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand, or Vietnam. For these people, the recommended first-line treatment is ceftriaxone. Also, azithromycin has been suggested to be better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. [30] Azithromycin significantly reduces relapse rates compared with ceftriaxone.

A separate problem exists with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.125–1.0 mg/l) would not be picked up by this method. [40] How this problem can be solved is not certain, because most laboratories around the world (including the West) are dependent on disk testing and cannot test for MICs.


Incidence of typhoid fever
 Strongly endemic
 Sporadic cases Fievre typhoide.png
Incidence of typhoid fever
 Strongly endemic
 Sporadic cases

In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths. [41] It occurs most often in children and young adults between 5 and 19 years old. [42] In 2013 it resulted in about 161,000 deaths – down from 181,000 in 1990. [13] Infants, children, and adolescents in south-central and Southeast Asia experience the greatest burden of illness. [43] Outbreaks of typhoid fever are also frequently reported from sub-Saharan Africa and countries in Southeast Asia. [44] [45] [46] Historically, in the pre-antibiotic era, the case fatality rate of typhoid fever was 10–20%. Today, with prompt treatment, it is less than 1%. [47] However, about 3–5% of individuals who are infected will develop a chronic infection in the gall bladder. [48] Since S. e. subsp. enterica is human-restricted, these chronic carriers become the crucial reservoir, which can persist for decades for further spread of the disease, further complicating the identification and treatment of the disease. [49] Lately, the study of S. e. subsp. enterica associated with a large outbreak and a carrier at the genome level provides new insights into the pathogenesis of the pathogen. [50] [51]

In industrialized nations, water sanitation and food handling improvements have reduced the number of cases. [52] Developing nations, such as those found in parts of Asia and Africa, have the highest rates of typhoid fever. These areas have a lack of access to clean water, proper sanitation systems, and proper health care facilities. For these areas, such access to basic public health needs is not in the near future. [53]

Ancient Greece

In 430 BC, a 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 typhoid fever 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. [54]

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. [55] 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.

Sixteenth and seventeenth centuries

A pair of epidemics struck the Mexican highlands in 1545 and 1576, causing an estimated 7 to 17 million deaths. [56] A study published in 2018 suggests that the cause was typhoid fever. [57] [58]

Some historians believe that the English colony of Jamestown, Virginia, died out from typhoid. Typhoid fever killed more than 6,000 settlers in the New World between 1607 and 1624. [59]

Nineteenth century

A long-held belief is that 9th US President William Henry Harrison died of pneumonia, but recent studies suggest he likely died from typhoid.

This disease may also have been a contributing factor in the death of 12th US President Zachary Taylor due to the unsanitary conditions in Washington, D.C., in the mid-19th century. [60] [61]

During the American Civil War, 81,360 Union soldiers died of typhoid or dysentery, far more than died of battle wounds. [62] 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. [63]

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. [64]

Twentieth century

Mary Mallon ("Typhoid Mary") in a hospital bed (foreground): She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until her death in 1938. Mary Mallon in hospital.jpg
Mary Mallon ("Typhoid Mary") in a hospital bed (foreground): She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until her death in 1938.
Original stool report for Mary Mallon, 1907. MaryMallon.stoolreport.1907.png
Original stool report for Mary Mallon, 1907.

In 1902 guests at mayoral banquets in Southampton, England and Winchester, England became ill and four died, including the Dean of Winchester, after consuming oysters. The infection was due to oysters sourced from Emsworth, where the oyster beds had been contaminated with raw sewage. [65] [66]

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 was closely associated with 53 cases and three deaths. [67] 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.

A notable outbreak occurred in Aberdeen, Scotland, in 1964. This was due to contaminated tinned meat sold at the city's branch of the William Low chain of stores. No fatalities resulted.

In 2004–05 an outbreak in the Democratic Republic of Congo resulted in more than 42,000 cases and 214 deaths. [42]



During the course of treatment of a typhoid outbreak in a local village in 1838, English country doctor William Budd realised the "poisons" involved in infectious diseases multiplied in the intestines of the sick, were present in their excretions, and could be transmitted to the healthy through their consumption of contaminated water. [68] He proposed strict isolation or quarantine as a method for containing such outbreaks in the future. [69] The medical and scientific communities did not identify the role of microorganisms in infectious disease until the work of Robert Koch and Louis Pasteur.

Organism involved

Almroth Edward Wright developed the first effective typhoid vaccine. Almroth Wright c1900.jpg
Almroth Edward Wright developed the first effective typhoid vaccine.

In 1880, Karl Joseph Eberth described a bacillus that he suspected was the cause of typhoid. [70] [71] [72] In 1884, pathologist Georg Theodor August Gaffky (1850–1918) confirmed Eberth's findings, [73] and the organism was given names such as Eberth's bacillus, Eberthella Typhi, and Gaffky-Eberth bacillus. Today, the bacillus that causes typhoid fever goes by the scientific name Salmonella enterica enterica , serovar Typhi.


The British bacteriologist Almroth Edward Wright first developed an effective typhoid vaccine at the Army Medical School in Netley, Hampshire. It was introduced in 1896 and used successfully by the British during the Boer War in South Africa. [74] At that time, typhoid often killed more soldiers at war than were lost due to enemy combat. Wright further developed his vaccine at a newly opened research department at St Mary's Hospital Medical School in London from 1902, where he established a method for measuring protective substances (opsonin) in human blood.

Citing the example of the Second Boer War, during which many soldiers died from easily preventable diseases, Wright convinced the British Army that 10 million vaccine doses should be produced for the troops being sent to the Western Front, thereby saving up to half a million lives during World War I. [75] The British Army was the only combatant at the outbreak of the war to have its troops fully immunized against the bacterium. For the first time, their casualties due to combat exceeded those from disease. [76]

In 1909, Frederick F. Russell, a U.S. Army physician, adopted Wright's typhoid vaccine for use with the US Army, and two years later, his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military. [77]

Chlorination of water

Lizzie van Zyl was a child inmate in a British-run concentration camp in South Africa who died from typhoid fever during the Boer War (1899-1902). LizzieVanZyl.jpg
Lizzie van Zyl was a child inmate in a British-run concentration camp in South Africa who died from typhoid fever during the Boer War (1899–1902).

Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. In 1908, the chlorination of public drinking water was a significant step in the US in the control of typhoid fever. The first permanent disinfection of drinking water in the U.S. was made in 1908 to the Jersey City, New Jersey, water supply. Credit for the decision to build the chlorination system has been given to John L. Leal. [78] The chlorination facility was designed by George W. Fuller. [79]


In 1942 doctors introduced antibiotics in clinical practice, greatly reducing mortality. Today, the incidence of typhoid fever in developed countries is around five cases per million people per year.


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

See also

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An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. These vaccines contrast to those produced by "killing" the virus.

Bartonella bacilliformis is a proteobacterium, Gram negative aerobic, pleomorphic, flagellated, motile, coccobacillary, 2–3 μm long, 0.2–0.5 μm wide, and a facultative intracellular bacterium.

<i>Salmonella enterica</i> subsp. <i>enterica</i> subspecies of bacterium

Salmonella enterica subsp. enterica is a subspecies of Salmonella enterica, the rod-shaped, flagellated, aerobic, Gram-negative bacterium. Many of the pathogenic serovars of the S. enterica species are in this subspecies, including that responsible for typhoid.


A super-spreader is a host—an organism infected with a disease—that infects, disproportionately, more secondary contacts than other hosts who are, also, infected with the same disease. A sick human can be a super-spreader; they would be more likely to infect others than most people with the disease. Super-spreaders are thus of high concern in epidemiology.

Edward Thomas Ryan American bacteriologist and epidemiologist

Edward T. (Thomas) Ryan is an American microbiologist, immunologist, and physician at Harvard University and Massachusetts General Hospital. Ryan served as President of the American Society of Tropical Medicine and Hygiene from 2009-2010. Ryan is Professor of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health, Professor of Medicine at Harvard Medical School, and Director of Global Infectious Diseases at the Massachusetts General Hospital. Ryan's research and clinical focus has been on infectious diseases associated with residing in, immigrating from, or traveling through resource-limited areas. Ryan is a Fellow of the American Society of Microbiology, the American Society of Tropical Medicine and Hygiene, the American College of Physicians, and the Infectious Diseases Society of America.

This is a Timeline of typhoid fever, describing major events such as scientific/medical developments and notable epidemics.


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  13. 1 2 GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC   4340604 . PMID   25530442.
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Further reading

External resources
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