Typhoid
Definition
An infection caused by Salmonella typhi, or S. paratyphi, starting with diarrhoea, and going systemic.
Epidemiology
Rare in the UK since our hygiene got so good, but common in the third world, and seen in UK people who have been abroad.
Clinical Features
Incubation takes about 10-14 days. Patient will get a fever or a rash, before starting to get abdominal pain, diarrhoea, constipation, for about a week.
During the second week, the patient may develop hepatosplenomegaly, shock, renal failure or coma.
Investigations
Gold standard is stool, blood or urine culture. However, transaminases (LFTs) may be raised.
Management
It's quite resistant these days, so the standard has become fluroquinolones, with steroids if that isn't working.
Prognosis
Treated, about 1-5% die, untreated more like 15%. 5% go on to become chronic carriers as the organism hides in the gall bladder.