Mary Mallon (1869-1938) and the history of typhoid fever


History of Medicine Department, Medical School, University of Athens, Athens, Greece

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History of Medicine Department, Medical School, University of Athens, Athens, Greece

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History of Medicine Department, Medical School, University of Athens, Athens, Greece

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History of Medicine Department, Medical School, University of Athens, Athens, Greece

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Received 2012 Sep 29; Accepted 2012 Nov 19.

Copyright : © Hellenic Society of Gastroenterology

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share A 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mary Mallon was born in 1869 in Ireland and emigrated to the US in 1884. She had worked in a variety of domestic positions for wealthy families prior to settling into her career as a cook.

As a healthy carrier of Salmonella typhi her nickname of “Typhoid Mary” had become synonymous with the spread of disease, as many were infected due to her denial of being ill.

She was forced into quarantine on two separate occasions on North Brother Island for a total of 26 years and died alone without friends, having evidently found consolation in her religion to which she gave her faith and loyalty.

Keywords: Typhoid fever, salmonella, Mary Mallon, carrier, New York

Long before the bacillus responsible for the disease was discovered in 1880, Karl Liebermeister had already assumed that the condition was due to a microorganism.

He also tried, with his colleagues, to demonstrate that the spread of epidemic was related to drinking water contaminated by the excrement of patients with typhoid fever [1].

William Budd, a doctor in Bristol who was interested in cholera and in intestinal fevers, demonstrated in 1873, that typhoid fever could be transmitted by a specific toxin present in excrement and that the contamination of water by the feces of patients was responsible for that propagation.

According to Budd, every case was related to another anterior case. A great number of doctors and scientists had tried to discover the nature of the microorganism responsible for the disease and had encountered great difficulty in isolating the bacillus.

It was Karl Joseph Eberth, doctor and student of Rudolf Virchow, who in 1879 discovered the bacillus in the abdominal lymph nodes and the spleen. He had published his observations in 1880 and 1881. His discovery was then verified and confirmed by German and English bacteriologists, including Robert Koch [2].

The genus “Salmonella” was named after Daniel Elmer Salmon, an American veterinary pathologist, who was the administrator of the USDA research program, and thus the organism was named after him, despite the fact that a variety of scientists had contributed to the quest [3]. Salmonella thus became new scientific knowledge and therefore the contagion mechanisms, as well as the existence of healthy carriers were relatively in status nascendi [4].

Mary Mallon was born in Ireland in 1869 and emigrated to the United States in 1883 or 1884.

She was engaged in 1906 as a cook by Charles Henry Warren, a wealthy New York banker, who rented a residence to Oyster Bay on the north coast of Long Island for the summer.

From 27 August to 3 September, 6 of the 11 people present in the house were suffering from typhoid fever. At this time, typhoid fever was still fatal in 10% of cases and mainly affected deprived people from large cities [5,6].

The sanitary engineer, committed by the Warren family, George Sober, published the results of his investigation on the 15th of June 1907, in JAMA.

Having believed initially that freshwater clams could be involved in these infections, he had hastily conducted his interrogation of the sick people and also of Mary who had presented a moderate form of typhoid [7].

Mary continued to host the bacteria, contaminating everything around her, a real threat for the surrounding environment. Although Sober initially feared that the soft clams were the culprits, this proved to be incorrect as not all of those stricken had eaten them.

Finally Sober had solved the mystery and became the first author to describe a “healthy carrier” of Salmonella typhi in the United States. From March 1907, Sober started stalking Mary Mallon in Manhattan and he revealed that she was transmitting disease and death by her activity.

His attempts to obtain samples of Mary’s feces, urine and blood, earned him nothing but being chased by her. Sober reconstituted the puzzle by discovering that previously the cook had served in 8 families. Seven of them had experienced cases of typhoid. Twenty-two people presented signs of infection and some died [5,6].

That year, about 3,000 New Yorkers had been infected by Salmonella typhi, and probably Mary was the main reason for the outbreak. Immunization against Salmonella typhi was not developed until 1911, and antibiotic treatment was not available until 1948 [4].

Thus, a dangerous source Mary had to be restrained. Mary was then frequently accused of being the source of contact for hundreds of the ill. Sober, after enlisting the support of Dr. Biggs of the N.Y. Department of Health, persuaded Dr.

Josephine Baker, who along with the police, was sent to bring Mary Mallon in for testing. Baker and the police were met by an uncooperative Mary, who eluded them for five hours. At the end she was forced to give samples.

Mary’s stool was positive for Salmonella typhi and thus she was transferred to North Brother Island to Riverside Hospital, where she was quarantined in a cottage [5].

In 1909, Mary unsuccessfully sued the health department. During her two-year period of confinement, she had 120/163 stool samples test positive. No one ever attempted to explain to Mary the significance of being a “carrier”, instead they had offered to remove her gallbladder, something she had denied.

She was unsuccessfully treated with Hexamethylenamin, laxatives, Urotropin, and brewer’s yeast. In 1910, a new health commissioner vowed to free Mary and assist her with finding suitable employment as a domestic but not as a cook. Mary was released but never intended to abide by the agreement.

She started working again in the cuisines of her unsuspecting employers, threatening public health once more [4].

As a cook of Sloane Maternity in Manhattan, she contaminated, in three months, at least 25 people, doctors, nurses and staff. Two of them died. She had managed to be hired as “Mary Brown” [8]. Since then she was stigmatized as “Typhoid Mary” (Fig.

1) and she was the butt of jokes, cartoons, and eventually “Typhoid Mary” appeared in medical dictionaries, as a disease carrier. Mary was placed back on North Brother Island where she remained until her death.

On Christmas morning, 1932, a man who came to deliver something to her found Mary on the floor of her bungalow, paralyzed. She had had a stroke of apoplexy and never walked again. Thereafter, for six years, she was taken care of in the “Riverside Hospital” (Fig. 2). She died in November 1938.

Her body was hurried away and buried in a grave bought for the purpose at St. Raymond’s Cemetery in Bronx. A post mortem revealed that she shed Salmonella typhi bacteria from her gallstones raising the issue of what would have happened if she had accepted the proposed operation.

Some other researchers insisted that there was no autopsy and that this was another urban legend, whispered by the Health Center of Oyster Bay, in order to calm ethical reactions [5].

Mary Mallon, the first known case of a healthy carrier in the United States, was proven responsible for the contamination of at least one hundred and twenty two people, including five dead [5].

Much speculation remains regarding the treatment that Mary received at the hands of the Department of Health, City of New York. She was never fined, let alone confined.

Instead of working with her, to make her realize she was a risk factor, the state quarantined her twice, making her a laboratory pet. Mary endured test after test and was only thinking of how she could cook again.

She had become a victim of the health laws, of the press and above all of the cynical physicians, who had plenty of time to test but never had time to talk with the patient [9,10].

Mary’s case is a perfect example of how the Health Care system provokes social attitudes towards disease carriers, often associated with prejudice.

This case highlighted the problematic nature of the subject and the need for an enhanced medical and legal-social treatment model aimed at improving the status of disease carriers and limiting their impact on society [9,10].

Probably the answer to the rhetorical question “was Mary Mallon a symbol of the threat to individual liberty or a necessary sacrifice to public health?” is a single word, “balance”. After all what Mary ever wanted was to be a good plain cook [11].

The history of Mary Mallon, declared “unclean” a leper, may give us some moral lessons on how to protect the ill and how we can be protected from illness. Mary had refused the one operation which might have cured her.

In later years she lost much of her bitterness and lived a fairly contented if necessarily restricted life. She evidently found consolation in her religion and she was then at perfect peace in the bosom of the church to which she gave the last years her faith and loyalty.

By the time she died New York health officials had identified more than 400 other healthy carriers of Salmonella typhi, but no one else was forcibly confined or victimized as an “unwanted ill”.

Mary Mallon is always a reference when mentioning the compliance of the laws concerning public health issues. The state’s pursuance and Mary’s stubbornness gave her an awkward place in the history of Medicine.

Conflict of Interest: None

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Articles from Annals of Gastroenterology are provided here courtesy of The Hellenic Society of Gastroenterology

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959940/

Typhoid Fever


Typhoid fever is a bacterial infection of the intestinal tract (bowels/gut) and occasionally the bloodstream caused by the Salmonella Typhi bacteria. This strain of bacteria lives only in humans. It is an uncommon disease with only a handful of cases occurring in New York each year. Most of the cases are acquired during foreign travel to developing countries.

Who gets typhoid fever?

Anyone can get typhoid fever but travelers visiting developing countries where the disease is common are at the greatest risk. Occasionally, local cases can occur from exposure to a person who previously recovered from typhoid but still carries the bacteria and sheds it in their feces (poop).

How is typhoid fever­­­ spread?

Salmonella Typhi lives only in humans. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract (bowels/gut). In addition, a small number of people, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (poop).

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is more ly to be contaminated with sewage.

What are the symptoms of typhoid and when do they appear?

Symptoms may be mild or severe and may include fever, headache, constipation or diarrhea (loose stool/poop), rose-colored spots on the trunk of the body, and an enlarged spleen and liver.

It is common for symptoms to go away and then appear again. Death occurs in less than 1 percent of those who get antibiotic treatment.

Symptoms generally appear one to two weeks after exposure to the bacteria.

How is typhoid diagnosed?

Symptoms may cause a health care provider to suspect typhoid fever, but a stool or blood test, which tests for the presence of the bacteria, is the only way to diagnose it.

How is typhoid treated?

Typhoid fever is treated with antibiotics. Resistance to multiple antibiotics is increasing among the Salmonella bacteria that cause typhoid fever, complicating treatment of infections. People who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection.

Should infected people stay school/work?

Most infected people may return to work or school when they have recovered, if they carefully wash hands after using the toilet. Children in daycare and health care workers must obtain the approval of the local or state health department before returning to their routine activities. Food handlers may not return to work until three consecutive negative stool cultures are confirmed.

Does past infection with typhoid make a person immune?

People can be reinfected if they come into contact with the bacteria again.

What can be done to prevent the spread of typhoid?

A vaccine is available for people traveling to developing countries where significant exposure may occur. For more information about vaccination, speak to your health care provider. It is equally important to pay strict attention to food and water precautions while traveling to countries where typhoid is common.

When drinking water in a developing country, you should buy it in a sealed bottle, boil it, or chemically treat it. When eating foods, avoid raw fruits and vegetables that cannot be peeled and washed, undercooked foods, and foods from street vendors. Additionally, food handlers may not work while sick with typhoid.

Source: https://www.health.ny.gov/diseases/communicable/typhoid_fever/fact_sheet.htm

Get vaccinated for typhoid:

  • Ask your doctor or nurse about a typhoid vaccine. This could be pills or a shot, and your doctor will help you decide which one is best for you.
    • Typhoid vaccine is only 50%-80% effective, so you should still be careful about what you eat and drink. (See tips below.)
  • See Vaccine Information Statements (VIS) for more information.


  • Food that is cooked and served hot
  • Hard-cooked eggs
  • Fruits and vegetables you have washed in clean water or peeled yourself
  • Pasteurized dairy products

Don't Eat

  • Food served at room temperature
  • Food from street vendors
  • Raw or soft-cooked (runny) eggs
  • Raw or undercooked (rare) meat or fish
  • Unwashed or unpeeled raw fruits and vegetables
  • Peelings from fruit or vegetables
  • Condiments (such as salsa) made with fresh ingredients
  • Salads
  • Unpasteurized dairy products
  • ”Bushmeat” (monkeys, bats, or other wild game)


  • Bottled water that is sealed (carbonated is safer)
  • Water that has been disinfected (boiled, filtered, treated)
  • Ice made with bottled or disinfected water
  • Bottled and sealed carbonated and sports drinks
  • Hot coffee or tea
  • Pasteurized milk

Don't Drink

  • Tap or well water
  • Ice made with tap or well water
  • Drinks made with tap or well water (such as reconstituted juice)
  • Flavored ice and popsicles
  • Unpasteurized milk
  • Fountain drinks

For more information see Food and Water Safety.

Practice hygiene and cleanliness:

  • Wash your hands often.
  • If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.


Source: https://wwwnc.cdc.gov/travel/diseases/typhoid

Typhoid Vaccination for International Travel


We’ll help keep you safe at home or abroad. Book your visit online today!

Typhoid fever, or typhoid, spreads through contaminated food or water. Caused by Salmonella typhi, typhoid fever is an acute illness infecting about 21.5 million people worldwide.

Typhoid fever can be fatal in up to 10% of reported cases. There has been an increase in the number of drug-resistant strains of Salmonella typhi since 1989. Unfortunately, drug resistance is spreading worldwide due to overcrowding, poor sanitation, inadequate control of infections and extensive international travel, trade and population movements.

Humans are the sole hosts of the bacteria which is shed in feces from 6 weeks to 3 months after infection. Most common symptoms include fever, anorexia, abdominal discomfort and headaches.

What Is the Typhoid Fever Vaccine?

There are two vaccines available to prevent typhoid fever:

  • Vivotif (Typhoid Vaccine Live Oral Ty21a) – Also known as ‘typhoid pills’, Vivotif is made from attenuated live bacteria. The vaccine provides up to five years’ protection and is approved for use in individuals over six-years-old. Vivotif is taken orally over the course of four doses.
  • Typhoid Vaccine (Injectable) – Made from inactive bacteria, the injectable typhoid vaccine provides protection for up to two years. This vaccine is approved for use in individuals over two-years-old.

The risk of either typhoid vaccination causing serious harm is rare and reactions to either vaccine are generally mild.

Do I Need a Typhoid Vaccine?

The typhoid vaccine is recommended for almost all international travelers. You may need the vaccine if they will be visiting smaller cities or rural areas.

The vaccine is highly recommended for regions with drug-resistant typhoid. This includes large portions Asia and Africa.

Where Does Typhoid Fever Occur?

The CDC recommends travelers headed to developing countries, where exposure to contaminated food or water is ly, receiving the typhoid vaccine. Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.

Where Can I Get the Typhoid Vaccine?

Both typhoid vaccines are in-stock and available at all Passport Health travel clinics throughout North America. Meet with a travel medicine specialist today to discuss your travel plans and receive your vaccine.

Overall rating: 5 stars – 20 reviews “The Best Customer Service Ever!!“
“The nurse was amazing. She went above and beyond to help my son when he lost his last pill of Typhoid. He had 1 pill left to finish his dose when he forgot it in a hotel. When I found out I reached out to Passport Health on what to do when medicine is lost. I was put in touch with the nurse to try and figure out a solution on how to get my son his last pill before he left to Thailand. Carol was kind and patient, she helped us find a solution and followed up to make sure the medicine was received. The bottom line is, in this day and age you don’t find customer service this anymore, when I was in a panic she made me feel everything was going to be ok and it was. Thank you from the bottom of my heart.” “Speedy Service“
“I called PH because I needed a typhoid shot for a mission trip that needed a last-minute replacement. No one else in Syracuse had the shot, and I had started to think I wouldn’t be able to get it, but PH found a spot for me the same morning I called.” “Necessary“
“Took both my kids to get vaccinated for Typhoid.” “Great Service“
“The process was super easy, they go in details about the pro and cons of each vaccines that arerequired, or recomended and what options there are for the vaccines ( typhoid which comes in 2 types, pills and shot) finally they provide you with additional services a document on your destination country which includes details about healthcare system of the country (is it save to have transfusion there?) and all kind of other general travel info.” “Thorough & professional“
“Administered Typhoid shot in little time with no problems.” “Excellent very educational“
“the nurse went over every scenario and disease that could possibly happen while my daughter visits Peru. She also explained to her how to take her malaria and typhoid pill. We also purchased the travelers medicine pouch in case she gets a stomach bug traveling.” “Great Service“
“My visit to PassportHealth in New York made me even more excited to travel. I received lots of information from the Director and she administered my Typhoid vaccine herself. It was quick and painless. I will absolutely return for future vaccinations.” “Excellent Friendly Service“
“I, my wife, and a friend needed yellow fever and Typhoid vaccinations for a trip to South America. We arrived for our appointments early and were taken on time. Everyone was very courteous, polite and friendly. The required inoculations were expertly administered. The shots were barely noticed when given.” “Very pleasant, thorough visit!“
“Great experience at the office – super informative, walked me through all of the health precautions, what to bring, what to look out for, and a lot of material to read and have on hand for my travels. Went for Typhoid shot, and came away with great advice, and reading materials.” “My Dad & I“
“My 86 year old father and I are going to Cuba. The RN was great giving us suggestions, explaining their products yet not pushing them at you. She told us what to be concerned about and take precautions, and what not to worry about. She had also been to Cuba so she was an excellent resource beyond the awesome job she did. Then she gave us our Typhoid shots I’m scared of needles even though I’m an RN too, she did such a good job–no pain. I hold other nurses at a standard being one myself. Great technique and she is very personal so she distracts you duriythe injection. All in all a great experience and you come out confident about where your going.” “Excellent and quick“
“The RN provided an excellent and speedy intake interview and vaccination – making the processes quite pleasant. She provided additional information for Typhoid, which I also got but wasn’t planning on getting the vaccination. I planned on getting Yellow Fever. I will come to Passport Health for my future travel needs; the operators over the phone were also quite excellent and helpful in providing me with last minute appointments.” “Very Thorough“
“I received very thorough information on the vaccines needed from the clinic. She offered coffee, tea and water as well as some ice to keep my Typhoid vaccine cold in transit.” “Easy Vaccination“
“I needed only a typhoid vaccine for an upcoming trip, but the Passport Health nurse printed out and reviewed with me all the recommended vaccines and area where, for example, malaria is prevalent to insure that I had all the immunizations I needed. I was not rushed; she was very pleasant and helpful.” “First Visit“
“The nurse covered what immunizations were needed in all four countries that we plan to visit in Africa. She also provided travel tips on what not to eat/drink, and what to take if we were to become sick. Besides selling us the Typhoid pills (note: best to bring a small cooler so that you can keep the pills below 45 degrees until you return home), she also has for sale other helpful meds available.” “An excellent Experience“
“I have visited Passport Health on two occasions in prep for my travels to Bali and Indonesia. Both visits were thorough and informative. I actually got Typhoid meds on my first visit and came home to check my medical records before taking Hep A. I was very pleased with the care items reviewed during my visit and have purchased additional items to ensure that I would get the most my travel. i.e. water bottles, mosquito spray, and sunscreen. Looking forward to enjoying my travels thanks to the counseling I received through Ms. Hennessy.” “Very quick“
“I was able to secure, via on-line, an appointment within 2 days. Arrived at the appointment and since I filled out forms on line Doreen was ready to review with me. She answered all o my questions and in addition to the Typhoid shot, I was able to secure my Malaria medicine. In and out in less than 20 minutes. I have already recommended to my friends that travel” “Helped us out in a bind“
“Passport Health helped us get the vaccines we needed on short notice. They also had the 5 year oral Typhoid vaccine that is unavailable elsewhere.” “Very helpful“
“The woman was very helpful, showing me the region I would be visiting and giving clear instructions on taking the oral Typhoid pills. The injections were all over before i realized it. Very skillful.” “Getting ready for Africa“
“My husband and I are planning a trip to Africa in the next few months. We went to the Frisco, TX location of Passport Health to receive our inoculations and oral medications for typhoid and malaria prevention. The RN was very knowledgeable, helpful and everything required was in stock. The inoculations were done professionally and we were both pleased with the service. Would definitely recommend Passport Health.” “Fast & Efficient“
“Had a wonderful quick visit. I was on my way to work that morning so it was great to have everything explained to me really carefully and clearly. I was offered 2 options for the typhoid vaccine, which was great! And the man who helped me was lovely!”

On This Page:
What Is Typhoid Fever?
What Is the Typhoid Fever Vaccine?
Do I Need a Typhoid Vaccine?
Who Should Get a Typhoid Vaccine?
Where Does Typhoid Fever Occur?
Where Can I Get the Typhoid Vaccine?

Source: https://www.passporthealthusa.com/vaccinations/typhoid/

Typhoid fever – Treatment


Typhoid fever can usually be treated successfully with a course of antibiotic medication.

Most cases can be treated at home, but you may need to be admitted to hospital if the condition is severe.

If typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed for you. Most people need to take these for 7 to 14 days.

Some strains of the Salmonella typhi bacteria that cause typhoid fever have developed a resistance to one or more types of antibiotics.

This is increasingly becoming a problem with typhoid infections originating in southeast Asia.

Any blood, poo (stool) or pee (urine) samples taken during your diagnosis will usually be tested in a laboratory to determine which strain you're infected with, so you can be treated with an appropriate antibiotic.

Your symptoms should begin to improve within 2 to 3 days of taking antibiotics. But it's very important you finish the course to ensure the bacteria are completely removed from your body.

Make sure you rest, drink plenty of fluids and eat regular meals. You may find it easier to eat smaller meals more frequently, rather than 3 larger meals a day.

You should also maintain good standards of personal hygiene, such as regularly washing your hands with soap and warm water, to reduce the risk of spreading the infection to others.

Contact your GP as soon as possible if your symptoms get worse or you develop new symptoms while being treated at home.

In a small number of cases, the symptoms or infection may recur. This is known as a relapse.

Staying off work or school

Most people being treated for typhoid fever can return to work or school as soon as they start to feel better.

The exceptions to this are people who work with food and vulnerable people, such as children under 5, the elderly and those in poor health.

In these cases, you or your child should only return to work or nursery after tests on 3 poo samples taken at 48-hour intervals have shown that the bacteria are no longer present.

Hospital admission is usually recommended if you have severe symptoms of typhoid fever, such as persistent vomiting, severe diarrhoea or a swollen stomach.

As a precaution, young children who develop typhoid fever may be admitted to hospital.

In hospital, you'll have antibiotic injections and you may also be given fluids and nutrients directly into a vein through an intravenous drip.

Surgery may be needed if you develop life-threatening complications of typhoid fever, such as internal bleeding or a section of your digestive system splitting.

But this is very rare in people being treated with antibiotics.

Most people respond well to hospital treatment and improve within 3 to 5 days, but it may be several weeks until you're well enough to leave hospital.

Some people who are treated for typhoid fever experience a relapse, which is when symptoms return.

In these cases, the symptoms usually return around a week after antibiotic treatment has finished.

The second time around, symptoms are usually milder and last for a shorter time than the original illness, but further treatment with antibiotics is usually recommended.

See your GP as soon as possible if your symptoms return after treatment.

After your symptoms have passed, you should have another stool test to check whether there are still Salmonella typhi bacteria in your poo.

If there are, you may have become a carrier of the typhoid infection. You may need to have a further 28-day course of antibiotics to “flush out” the bacteria.

Until test results show that you're free of bacteria, avoid handling or preparing food.

It's also very important that you wash your hands thoroughly after going to the toilet.

Source: https://www.nhs.uk/conditions/typhoid-fever/treatment/

Typhoid Fever Causes, Symptoms, Treatment and Vaccine


Typhoid fever is an acute illness associated with fever caused by the Salmonella enterica serotype Typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

The incidence of typhoid fever in the United States has markedly decreased since the early 1900s, when tens of thousands of cases were reported in the U.S.

Today, less than 400 cases are reported annually in the United States, mostly in people who have recently traveled to Mexico and South America. This improvement is the result of better environmental sanitation.

India, Pakistan, and Egypt are also known as high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease.

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized. These people may become long-term carriers of the bacteria — even though they have no symptoms — and be the source of new outbreaks of typhoid fever for many years.

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream.

People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples.

If a test result isn't clear, blood or urine samples will be taken to make a diagnosis.

The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks. Symptoms include:

  • Poor appetite
  • Headaches
  • Generalized aches and pains
  • Fever as high as 104 degrees Farenheit
  • Lethargy
  • Diarrhea

Chest congestion develops in many people, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of people have recurrent symptoms after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%.

Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 1%-2%.

With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.

Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics.

The choice of antibiotics is guided by identifying the geographic region where the infection was contracted (certain strains from South America show a significant resistance to some antibiotics.

) If relapses occur, patients are retreated with antibiotics.

Those who become chronically ill (about 3%-5% of those infected), can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will provide a cure.

For those traveling to high-risk areas, vaccines are now available.

  • Typhoid fever is caused by Salmonella enterica serotype Typhi bacteria.
  • Typhoid fever is contracted by the ingestion of contaminated food or water.
  • Diagnosis of typhoid fever is made when Salmonella bacteria are detected with stool, urine, or blood cultures.
  • Typhoid fever is treated with antibiotics.
  • Typhoid fever symptoms are poor appetite, headaches, generalized aches and pains, fever, and lethargy.
  • Approximately 3%-5% of patients become carriers of the bacteria after the acute illness.

SOURCE: Centers for Disease Control.

Typhoid Fever from MedicineNet.

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Source: https://www.webmd.com/a-to-z-guides/typhoid-fever