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| Typhoid | |
 | |
| Bloody diarrhea characteristic of typhoid. | |
| Information | |
| Region (s) | Africa, South America and central, Asia (except the Russia) |
|---|---|
| Cause | Bacterium |
| Vector | Drinks, food |
| Contagiousness |  no |
| CIM-10 | A01.0 |
| CIM-9 | 002.0 |
| Prophylaxis: | |
| * vaccine |  Yes |
| * medication | no |
| Therapy: | Yes |
| Location | |
 | |
| Geographical areas of typhoid. | |
 Medical warning | |
The typhoid (from ancient Greek τῦφος tuphos meaning "torpor"), also called typhoid fever Where enteric fever Where abdominal typhus is an infectious disease of the type salmonellosis caused by an enterobacterium of the species Salmonella typhi.
Understand
It is the lack of hygiene, and more particularly that brought to the food, which is the main cause of the spread of this diarrheal disease. According to a study byWHO published in 2013, 21 million people are affected by typhoid worldwide and between 200,000 and 600,000 die each year.
The estimated risk of contracting typhoid while traveling is approximately 1 in 3,500 travelers to South Asia, from 1 in 50,000 to 100,000 in Africa sub-Saharan and South America and less than 1 in 300,000 travelers in Caribbean and in central America.
The reservoir of Salmonella typhi is strictly human and one of the epidemiological features of this infection is that there are healthy carriers of the bacteria. After recovery from typhoid fever 2 to 5% of individuals continue to harbor Salmonella typhi, mainly in the gallbladder, which are excreted episodically in the stool and which can therefore be the cause of secondary cases.
Vector protection
The vector being human feces having soiled the water or food, the protection will be identical to that applied against all food poisoning:
- peel fruits and vegetables, avoid unpasteurized milk, raw eggs, raw vegetables and undercooked meat, cook food over 65 ° C, only drink drinks uncapped in front of you otherwise water that has been imperatively boiled or purified by adding a chlorine tablet, avoid ice cubes, do the same for brushing teeth,
- wash your hands with soap before each meal, before and after going to the toilet or changing an infant, otherwise use a hand sanitizer.
Protection against bacteria
There are two types of vaccines on the market.
- Live attenuated strain vaccine for oral administration, active from 7 days after the end of treatment, from the age of five years, efficacy of seven years:
- Vivotif®
Europe: one capsule on days 1, 3 and 5, on an empty stomach, 1 h before the meal - Canada: one capsule on days 1, 3, 5 and 7, on an empty stomach, 1 h before the meal or 2 h after this one. 
box of 3 tablets - Belgium: 20,34 € - France: not marketed - Switzerland: 33,8 Fr. ; box of 4 tablets - Canada: 21 $ C. – Drug information.
- Vivotif®
- Inactivated vaccine for parenteral administration, from the age of two years, active from 14 days after inoculation, efficacy of three years:
- Typhim Vi® intramuscular injection. pre-filled syringe with 0.5 mL - Belgium : 26,02 € - Canada: 22 $ C - France: free price with an average of 27,5 € ; box of 20 doses in vial - Canada: 391 $ C. – Drug information.
- Typherix® intramuscular injection. pre-filled syringe with 0.5 mL - Belgium: not marketed - Canada: not marketed - France: free price with an average of 27,5 € - Tunisia: 15 434 TND. – Drug information.
- Typhim Vi®
Europe: one capsule on days 1, 3 and 5, on an empty stomach, 
box of 3 tablets - Belgium: There is also a combined vaccine against typhoid andhepatitis A. These are the specialties Tyavax®, in France, and ViVAXIM®, in Canada. Both are marketed in pre-filled double compartment syringes containing 1 mL to be administered intramuscularly to subjects of at least 16 years of age. Protection begins after 14 days for a period of 6 to 36 months against hepatitis A and 3 years against typhoid.
Diagnostic
There is no test that is effective enough to show for sure that it is indeed a typhoid. It's'history taking into account the patient's symptoms and the trips he has taken combined with a series of clinical examinations ruling out other possible infections which will lead the doctor to favor the diagnosis of one typhoid over another.
As with any infection, it is customary to distinguish three phases:incubation, the'invasion and thestate.
Symptoms
- During incubation:
- this varies between one and three weeks and depends on the infectious dose received;
- no symptoms.
- During the invasion:
- headache but not stiff neck, insomnia, asthenia ;
- fever progressive installation up to 40 ° C with pulse-temperature dissociation (that is, without pulse acceleration);
- meteorism ;
- epistaxis ;
- a state of stupor and extreme depression, called "tuphos", characteristic not only of typhoid but also of paratyphoid and typhus. This torpor which can go as far as prostration and delirium is the sign of the destruction of Salmonella typhi either by the body's immune system, or by the anti-bacterial if treatment has started. It should however be borne in mind that during this destruction, the bacterium releases an endotoxin responsible for ulcers of the digestive system which can cause hemorrhages or even perforation;
- a whitish tongue while the tip and edges remain red is also a typical feature of typhoid.
- During the state:
- fever continues between 39 and 40 ° C always with a pulse-temperature dissociation;
- red spots on the back, stomach and chest while the paratyphoid causes red spots all over the body;
- increasingly severe bloody diarrhea;
Clinical signs
- During the state phase, splenomegaly detectable by palpation of the abdomen as well as ulceration of the tonsils;
- the bacteria are found in venous blood cultured in 25 to 60% of cases and in stools placed in stool culture in 40 to 60% of cases;
- no blood abnormalities are specific to the infection even during the state phase;
- the pathogen is found in the stool and urine inconsistently;
- the presence of antibodies directed against the antigens of the bacterium does not make it possible to distinguish a current infection from an old and cured disease or from a previous vaccination. In addition, this serology, called Widal's test, requires two samples, the second showing a minimum increase of four times the initial titer, two weeks apart. Its positivity or negativity is therefore late and the false positive reactions observed are numerous: fever, malaria, septicemia, immunological disorder;
- the test TSI shows a black precipitate in the middle of the test tube showing the production of hydrogen sulfide specific to bacteria of the genus Salmonella.
Therapy
The patient must be hospitalized, placed in isolation and the nursing staff wear gloves. The patient should be given rehydration fluid, intravenously if necessary, to compensate for fluid loss due to diarrhea and given an antibiotic for 10 to 15 days. In first intention, in adults, a fluoroquinolone or ceftriaxone will be most often used while in children under fifteen years, the combination co-trimoxazole or ampicillin will often be preferred.
Treatment with an antipyretic for fever may also sometimes be necessary.
Possible consequences
After recovery, 2 to 5% of individuals continue to harbor Salmonella typhi, mainly in the gallbladder, which are excreted episodically in the stool and which can therefore be the cause of secondary cases. With very strong bacteremia in the bloodstream, bacteria can reach the lungs causing pneumonia, or the lining of the brain (meningitis), the bones (osteomyelitis), the valves of the heart (endocarditis), the kidneys (glomerulonephritis) , the genital or urinary tract, or the muscles. A hepatitis is also possible. Without treatment, 10 to 15% of patients die, especially if they are under 15 or over 60.
Remarks
- This disease is on the list of notifiable infectious diseases in Belgium, in France, to Quebec, in Swiss as well as in Algeria, to Morocco and in Tunisia.
- Do not confuse typhoid, carried by contaminated food, and typhus, carried by an arthropod.
- Do not confuse typhoid and paratyphoid caused by different subspecies of Salmonella with different symptoms and possible consequences.
- Vivotif® live strain vaccine is contraindicated for pregnant women, people with acute gastrointestinal disease, chronic inflammatory bowel disease, and immunocompromised people.
- Taking proguanil, mefloquine and antibiotics should be stopped three days before and up to three days after the administration of Vivotif® live strain vaccine. This must be taken into account if you have chosen the mefloquine, such as Lariam®, as a prophylactic drug antimalarial since taking it must begin two to three weeks before departure.
Further information
- Health topics, Food safety – The food safety page on the WHO website.
