Typhoid fever

Typhoid fever is a life-threatening disease of the intestinal system caused by the typhoid bacillus, Salmonella typhosa, which lives only in humanswho carry it in their bloodstream and intestinal tract. Typhoid fever is spread when the bacteria is "shed" by infected people who handle food or fluidswithout washing their hands, or when sewage carrying the bacteria contaminates water, milk, and other foods. Although relatively rare since the advent ofvaccines and improvement of public sanitation (about 400 cases are reported annually in the United States, 70% of which are acquired through internationaltravel), typhoid fever was once common and still arises in impoverished areas of the world where squalid conditions prevail and medical treatment is unavailable. Symptoms of the disease become evident within one to two weeks afterinfection and include sore throat, fever, headache, nausea, and loss of appetite, which are sometimes followed by the appearance of red spots on the chest and abdomen and, in severe cases, delirium and death. As the bacteria invade the intestines, they cause ulcerations and bleeding. This can lead to holesin the intestines and the bacteria can invade the bloodstream and sometimesspread to the bone marrow or spinal cord causing meningitis. The fever generally lasts three to four weeks and then subsides.

Treatment for typhoid includes cold sponge baths to lower the fever and plenty of liquids to avoid dehydration. Antibiotics, such as chloramphenicol, arealso effective.

One of the first clinical descriptions of typhoid fever was made by English physician Thomas Willis (1621-1675). French physician Pierre-Fidèle Bretonneau (1778-1862) was the first to accurately describe the progression of the disease in 1819. He went on to detail a typhoid epidemic in France, and reported that the disease was transmitted by contact with other contaminated people. Bretonneau also distinguished between typhoid fever and a form of typhus that were often mistaken.

Almroth Edward Wright, an English physician, conducted research in blood coagulation and developed a vaccine against typhoid fever in 1889. The vaccine was effective when tested on soldiers during the Boer War. During World War I,British soldiers were the only ones vaccinated and their incidence of typhoidfever was greatly reduced. Wright went on to conduct important work in bacteriology and was knighted in 1906.

Scottish physician William Boog Leishman (1865-1926) is also credited with developing a vaccine against typhoid fever which was effectively used during the war. Much later, during the 1960s and 1970s, Margaret Pittman and others were involved with comparative studies of typhoid vaccines.

Researchers learned that the disease was spread through contaminated food andthat, often, carriers of the disease showed no symptoms. Such was the case of Mary Mallon (1870?-1938), a cook who earned the nickname Typhoid Mary because she carried the bacillus for typhoid fever. Josephine Baker, a pioneer inpublic sanitation, succeeded in tracking down Mallon and from 1907 until 1910the cook was hospitalized while experts attempted, unsuccessfully, to eradicate the bacillus. She was then released with the understanding that she wouldreport for regular testing and also find a new profession. Mallon subsequently disappeared and, after a five-year hiatus, was once again apprehended andquarantined for the remainder of her life.

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