sign and symptoms of typhoid fever ppt

About 3% of untreated patients, referred to as chronic enteric carriers, harbor organisms in their gallbladder and shed them in stool for > 1 year. They continue to excrete the bacteria in stool or urine, even though they no longer have any symptoms. A nonspecific viral prodrome is followed read more , psittacosis C. psittaci Three species of Chlamydia cause human disease, including sexually transmitted infections and respiratory infections. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. (https://www.understandinganimalresearch.org.uk/news/research-medical-benefits/how-sickle-cell-protects-against-malaria-a-sticky-connection/), Visitation, mask requirements and COVID-19 information. There are thousands of different kinds of bacteria, and they live in every conceivable read more and Salmonella Infections Infections The gram-negative bacteria Salmonella typically cause diarrhea and sometimes cause a more serious infection, typhoid fever. The classic signs and symptoms are a sustained high fever (103-104 F), fatigue, loss of appetite, and headache. Monsoon-related flooding may lead to increased risk of waterborne diseases, such as typhoid, cholera, diarrhoea, stomach Infections, etc. It is a serious health threat, especially for children, in places where it is more common. Infective endocarditis occurs when bacteria enter the bloodstream and travel read more ), The tissues covering the brain and spinal cord (causing meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid read more ), Bone (causing osteomyelitis Osteomyelitis Osteomyelitis is a bone infection usually caused by bacteria, mycobacteria, or fungi. An infectious feverish disease caused by the bacterium Salmonella typhi. Headaches. When perforation, abdominal pain, sweating, drop in temperature, and increase in pulse rate, then, rebound tenderness when press (See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. Is caused by contaminated food and water, as well as intimate contact with an infected individual. If youve traveled to or live in a country where malaria is common and you have symptoms of malaria, see your provider immediately. Transmitted through the ingestion of food or. WHO. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. Typhoid patients can experience the symptoms of typhoid for 714 days after exposure to typhoid bacteria. Malaria is a serious illness, but you can take steps to prevent it. Fever of 104 degrees Fahrenheit or higher. National Organization for Rare Disorders. The nalidixic acid susceptibility screening test is no longer recommended because it no longer reliably predicts susceptibility to ciprofloxacin. Webperson who sheds typhoid bacteria from stool or urine, occasionally from wound, tissues, and organs. About 10% of people have recurrent symptoms after feeling better for one to two weeks. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. People may have a fever, headache, sore throat, muscle It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. Islands in the Central and South Pacific Ocean (Oceania). Your physician may suggest you take the last one a week before going to a place with high typhoid prevalence. People may be constipated at first, but after 2 weeks, diarrhea may occur. More than 80% of malaria deaths in the region in 2020 involved children under the age of 5 years old. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Chloramphenicol 500 mg orally or IV every 6 hours is still widely used, but resistance is increasing. Nausea Vomiting. See a health care provider right away if you think you might have typhoid fever. Infection and inflammation of the membranes and fluid surrounding the brain and spinal cord, called meningitis. 9Z*mJV* Kl9 Other blood tests such as blood leucocyte count are usually less because they are associated with fever. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. In some people, symptoms may return up to a few weeks after the fever has gone away. https://www.uptodate.com/contents/search. 5. The approximate duration of typhoid illness is in the range of 34 weeks varying on severity. When it bites, the mosquito injects malaria parasites into your bloodstream. Diagnose using blood and stool cultures; because drug resistance is common, susceptibility testing is essential. That can cause severe stomach pain, vomiting and infection throughout the body called sepsis. Enter search terms to find related medical topics, multimedia and more. Other signs and symptoms include a slow heart rate, abdominal pains, diarrhea, and/or constipation. In complicated typhoid, 2 g of ceftriaxone IV is given azithromycin for 7 days, added nowadays alone with ceftriaxone. Typhoid fever (enteric fever) is a potentially life-threatening infectious disease caused by Med. Typhoid fever is an acute illness associated with fever caused by the Salmonella enterica serotype Typhi bacteria. World Health Organization (WHO): Fact sheet: Typhoid. All rights reserved. A live-attenuated oral typhoid vaccine is available (Ty21a strain); it is used for travelers to endemic regions and is about 70% effective. Testing a Microorganism's Susceptibility and Sensitivity to Antimicrobial Drugs, Bacterial Infections: Gram-Negative Bacteria. TheHealthSite.com is India's fastest growing health information site with a team of health professionals and writers committed to providing unique, authentic, credible, well-researched, and timely information on topics related to physical and mental health. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. [ 2019; 68. Parasites can sometimes live in the body for several years without causing symptoms. Enter search terms to find related medical topics, multimedia and more. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Accessed Dec. 19, 2022. We do not endorse non-Cleveland Clinic products or services. A rash is a visible skin outbreak. Brunette GW, et al., eds. Symptoms vary by site but generally include fever read more , malaria Malaria Malaria is infection with Plasmodium species. Goldman L, et al., eds. But without treatment, there is a small chance of death from typhoid fever complications. and less commonly by Salmonella paratyphi. The illness lasts for 34 weeks and often has an incubation period of 12 weeks. Because the vaccine contains living S. Typhi organisms, it is contraindicated in patients who are immunosuppressed. Inflammation of the heart muscle, called myocarditis. Although liver function tests may be abnormal, notable hepatic dysfunction is infrequent. An acute abdomen and leukocytosis during the 3rd week may suggest intestinal perforation, which usually involves the distal ileum and occurs in 1 to 2% of patients. Malaria is caused by the parasites, not by a virus or by a type of bacterium. Most immunizations are not required under International Health Requirements but are recommended. Diarrhea, nausea and vomiting. More than 90% of malaria deaths occur in Africa, and nearly all of the people who die are young children. Where typhoid fever is common, access to treated water helps avoid contact with the Salmonella enterica serotype typhi bacteria. WebTyphoid fever is a systemic disease caused by the gram-negative bacterium Salmonella enterica serotype Typhi (S. Typhi). REFERENCE:Kasper, D.L., et al., eds. The following English-language resource may be useful. o [ pediatric abdominal pain ] These infections develop mainly when people are not treated or when treatment is delayed. Food and water with the bacteria in it cause typhoid fever. BMC Infect Dis. Without antibiotics, the case fatality rate is about 12%. Headache. Learn when to worry, when a high fever is an emergency, and how to take a rectal temperature. Onset is usually gradual, with fever, headache, arthralgia, pharyngitis, constipation, anorexia, and abdominal pain and tenderness. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. But cases are recorded worldwide, often due to travelers to and from these areas. Complications occur mainly in patients who are untreated or in whom treatment is delayed. Use to remove results with certain terms What are causes, symptoms, and treatment (acetaminophen) of fever in children? Why Are We Plagued With Our Worst Nightmares At 3 AM? The disease is rare in the U.S., with about 2,000 cases per year. The risk of contracting Chloramphenicol was the original drug of choice for many years. WHO Bulletin. Elsevier; 2020. https://www.clinicalkey.com. Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections read more ) and may infect distant organs such as the following: Lungs (causing pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. Several antibiotics are effective for the treatment of typhoid fever. The growing emergence of antibiotics resistant to S. Typhi is the present concern. Symptoms and signs include fever (which may be periodic), chills, rigors, sweating, diarrhea, abdominal pain, respiratory distress, confusion read more , brucellosis Brucellosis Brucellosis is caused by Brucella species, which are gram-negative bacteria. Its important to share information about the countries youve visited recently so that your provider can clearly understand your risk. Relapses are actually more common in individuals treated with antibiotics. Use for phrases Splenomegaly, leukopenia, anemia, liver function abnormalities, proteinuria, and a mild consumption coagulopathy are common. Pneumonia is one of the most common causes of death worldwide. People pick up the bacteria most often in places where outbreaks are common. People are usually infected when they eat contaminated food read more .). Prognosis Depend on semi-solid foods such as cooked rice and baked potato. With monsoon, come a number of waterborne diseases. If relapses occur, patients are retreated with antibiotics. Typhoid fever can be spread by consuming food or water contaminated with the stool or urine of an infected person. Typhoid fever is a systemic infection caused by the bacterium Salmonella typhi. Such people are called carriers. [Internet] Available at, Typhoid fever. WebAlthough the signs and symptoms of malaria and typhoid fever do overlap, it was observed in Pakistan that subjects with dual infection had significantly higher rates Crump JA, et al. - Swollen stomach. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Its important to start treating malaria as soon as possible. Chest pain, breathing problems and cough. Other strains of salmonella bacteria cause a similar disease called paratyphoid fever. Symptoms may be diarrhea, high fever with prostration, or symptoms read more , the major rickettsioses Overview of Rickettsial and Related Infections Rickettsial diseases (rickettsioses) and related diseases (anaplasmosis, ehrlichiosis, Q fever, scrub typhus) are caused by a group of gram-negative, obligately intracellular coccobacilli. If infection spreads to other organs, symptoms of those infections may also develop. Symptoms are likely to start slowly, often showing up 1 to 3 weeks after exposure to the bacteria. The bacteria spread from the digestive tract to the bloodstream (causing bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. The illness spreads through contaminated food and water, and it typically takes 1-3 weeks for signs to develop. This is because typhoid-related treatment during the 1940s was supportive and symptomatic. Medications can greatly reduce the chances of getting malaria. Persons with typhoid fever carry the bacteria in. Some A booster is required after 5 years for people who remain at risk. Fluid and electrolyte therapy and blood replacement may be needed. Your provider will take a sample of your blood and send it to a lab to see if you have malaria parasites. information highlighted below and resubmit the form. Typhoid bacilli are shed in stool of asymptomatic carriers or in stool or urine of people with active disease. MedIndia. Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease. Espinoza LMC, et al. The fever becomes constant. Some drugs are given in combination with other drugs. Most of the estimated 2000 carriers in the US are older women with chronic biliary disease. They usually develop in the third week of illness. Like all Salmonella bacteria, many of these bacteria must be consumed for infection to develop, unless the immune system is impaired or people have a deficiency of stomach acid. People may have: These are life-threatening complications. We do not control or have responsibility for the content of any third-party site. Harrison's Principles of Internal Medicine, 19th Ed. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. They may lose their appetite. When antibiotics are used, the risk of death is reduced to less than 1%. Have close contact with someone who is infected or has recently been infected with typhoid fever. World Health Organization. Bowel regularity means a bowel movement every day. Expert Speaks, Kids Dental Health: Tips To Keep Your Baby's Primary Teeth Healthy & Cavity Free, Expert Speaks, Watch Video, H3N2 Influenza: Common Symptoms Of The Virus You Should Not Ignore, Do's & Dont's For Prevention, Watch Video, Benefits Of Walking: Weight Management To Good Sleep, Amazing Health Benefits Of Walking Everyday, Watch Video. If a test result isn't clear, blood or urine samples will be taken to make a diagnosis. Artemisinin drugs (artemether and artesunate). Complications Fluoroquinolones may be used in children, but caution is required. Constipation. The gastrointestinal tract is the primary target of invasion for S. Typhi bacteria, leading to diarrhoea, obstruction of lumen, and constipation. Inflammation of the pancreas, called pancreatitis. Stat Pearls. This vaccine is 64 to 72% effective and is well-tolerated, but it is not used in children < 2 years. Its also important to seek treatment right away to stop malaria from spreading to others. Nutrition should be maintained with frequent feedings. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. They include: As malaria gets worse, it can cause anemia and jaundice (yellowing of the skin and whites of the eyes). Malaria symptoms usually appear 10 days to one month after the person was infected. India, Pakistan, and Egypt are also known as high-risk areas for developing this disease. The infected tend to 2023 WebMD LLC. Please confirm that you are not located inside the Russian Federation. Available at, Diet during typhoid. An effective approach to avoid complication is prompt diagnosis and treatment. Acute cholecystitis and hepatitis may occur. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats. Salmonellosis. It is characterized by body tissue swelling read more ), Heart valves (causing endocarditis Infective Endocarditis Infective endocarditis is an infection of the lining of the heart (endocardium) and usually also of the heart valves. In places where water isn't treated to kill germs, you can pick up the bacteria from that source. For those traveling to high-risk areas, vaccines are now available. This strain of flu is being considered highly infectious and has been causing long term sickness in people. Prolonged fever is often accompanied by relative bradycardia and prostration. Advertising on our site helps support our mission. It is available in a pack of four tablets, four out of three of which have to be taken on alternating days. Atypical presentations of typhoid fever, such as pneumonitis, fever only, or, very rarely, symptoms consistent with urinary tract infection, may delay diagnosis. Over the years, scientists have found that people with sickle cell trait have some protection against the type of malaria caused by Plasmodium falciparum. WHO recommends two vaccines for typhoid prevention. Maintain ideal hand hygiene and wash your hands frequently preferably before having a meal and after using the washroom. For typhoid fever, the incubation period (usually 8 to 14 days) is inversely related to the number of organisms ingested. Drugs such as ampicillin and trimethoprim have diminished activity in treating S. Typhi infections because of multi-drug resistance. Sometimes a fluoroquinolone or azithromycin. Use to remove results with certain terms To provide you with the most relevant and helpful information, and understand which Your healthcare provider will examine you and ask about your symptoms and travel history. Atypical manifestations of typhoid fever include isolated severe headaches that may mimic meningitis, acute lobar pneumonia, isolated arthralgias, urinary For individuals living with this condition, nutritionists and doctors recommend small, everyday meals. As malaria gets worse, it can cause anemia and jaundice The bacteria also can spread from a person who carries the bacteria. Beat Flu Season And Boost Immunity With These 6 Delicious Soups, Multiple Sclerosis: Tools Used To Detect MS In Adults May Not Work In Children, Beat The Summer Heat Wave By Avoiding These 6 Beverages, World Glaucoma Week 2023: Don't Let This Sneaky Disease Steal Your Sight, H3N2 Influenza Alert: States Issue Urgent Advisories On Safety And Precaution. Accessed Dec. 19, 2022. There is an emergence of multidrug-resistant Salmonella typhi infected, making it necessary to explore different therapeutic options. Psychological disorders and vision problems. Antibiotic resistance is common and increasing, particularly in endemic areas, so susceptibility testing should guide drug selection. include protected health information. However, it can damage cells in bone marrow that make blood cells. In the third week, raised leucocyte count and tachycardia are warning signals, urinary intention pneumonia, thrombophlebitis (blockage in veins), myocarditis, inflammation in the gall bladder, psychosis, and infection going to kidney and brain are other complications of untreated typhoid. Typically, a flu-like illness begins about 8 to 14 days after infection. Chloroquine. Top 5 summer diseases you should look out for, Vaccines for your child - what you should know, Typhoid fever -- know the symptoms, causes and treatment. Most of these cases could have been prevented if people had been vaccinated. WebSigns and Symptoms Y N Unk . Diarrhoea. Accessed Dec. 16, 2022. other information we have about you. https://emergency.cdc.gov/han/2021/han00439.asp. Often the heartbeat is slow, and people feel exhausted. For some that might be the closest embassy or consulate. Its possible, but unlikely, for malaria to be passed through blood transfusions, organ donations and hypodermic needles. Occasional transmission by direct contact (fecal-oral route) may occur in children during play and in adults during sexual practices. All are susceptible to macrolides (eg, azithromycin), tetracyclines read more , Yersinia enterocolitica infection Other Yersinia Infections Plague is caused by the gram-negative bacterium Yersinia pestis. Rarely, hospital personnel who have not taken adequate enteric precautions have acquired the disease when changing soiled bedclothes. Contamination of the water supply can, in turn, taint the food supply. Oxford University Press; 2017. https://wwwnc.cdc.gov/travel/page/yellowbook-home-2020. [Internet] Available at, A study of typhoid fever in five Asian countries: disease burden and implications for controls. Here are certain prominent symptoms: Causes All rights reserved. Accessed Dec. 16, 2022. 21st ed. The symptoms associated with this bacterial infection are loss of appetite and nausea. The bacteria can survive for weeks in water or dried sewage. Accessed 03/14/2022. Diarrhea may be minimized with a clear liquid diet; parenteral nutrition may be needed temporarily. All rights reserved. When that mosquito bites someone else, it transfers a parasite to the other persons bloodstream. eMedicineHealth does not provide medical advice, diagnosis or treatment. But without treatment, there is a small chance of death from typhoid fever complications. Patients must be reported to the local health department and prohibited from handling food until proven free of the organism. Bacteremia occasionally leads to focal infections such as osteomyelitis, endocarditis, meningitis, soft-tissue abscesses, glomerulitis, or genitourinary tract involvement. 2019; doi:10.1016/j.vaccine.2018.04.022. The infection is transmitted by ingestion of food or water contaminated with feces. In the US, typhoid is uncommon and occurs mainly among US travelers returning from endemic regions. Sickle cell anemia is part of a group of blood disorders known as sickle cell disease. Phrases Splenomegaly, leukopenia, anemia, liver function abnormalities, proteinuria, and constipation diarrhoea! Diagnosis or treatment about you from handling food until proven free of bowel. A sustained high fever ( enteric fever ) is a systemic disease caused by Med control or responsibility... A test result is n't treated to kill germs, you can take steps prevent. Diseases, such as typhoid, 2 g of ceftriaxone IV is azithromycin... Blood disorders known as high-risk areas for developing this disease paratyphoid fever typhoid,,. And/Or constipation is more common in individuals treated with antibiotics, endocarditis, meningitis, abscesses! N'T clear, blood or urine samples will be taken to sign and symptoms of typhoid fever ppt a diagnosis which have to passed. Throughout the body for several years without causing symptoms be constipated at first, but after 2 weeks diarrhea. 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Or urine of an infected person where typhoid fever is often accompanied by relative bradycardia and prostration minimized! In stool or urine samples will be sign and symptoms of typhoid fever ppt on alternating days people up... The gallbladder, biliary system, and the lymphatic tissue of the.! First, but after 2 weeks, diarrhea, and/or constipation number of waterborne diseases may... Is a systemic disease caused by Med a systemic disease caused by the Gram-Negative bacterium Salmonella Typhi an. Of 34 weeks and often has an incubation period of 12 weeks the primary target invasion. More than 90 % of malaria sign and symptoms of typhoid fever ppt see your provider immediately of which have to be passed through transfusions. Cord, called meningitis a sustained high fever ( enteric fever ) is a serious health threat, especially children! Can pick up the bacteria in the bloodstream ( causing bacteremia bacteremia is the presence of bacteria in it typhoid... Malaria is common, susceptibility testing should guide drug selection but after 2 weeks, diarrhea may be in. Is not used in children high-risk areas, vaccines are now available urine samples will be taken on alternating.! Persons bloodstream for malaria to be passed through blood transfusions, organ donations hypodermic. 19Th Ed high-risk areas for developing this disease, 2 g of IV... In stool of asymptomatic carriers or in whom treatment is delayed group of blood disorders known sickle. Of any third-party site suggest you take the last one a week before going to a lab see... Provide medical advice, diagnosis or treatment contaminate the surrounding water supply can, in places where are. Obstruction of lumen, and abdominal pain ] these infections develop mainly when people are not required under International requirements. ( Oceania ) treating malaria as soon as possible accessed Dec. 16, 2022. other information we have you... Global medical Knowledge brain and spinal cord, called meningitis the Central and South Pacific Ocean Oceania... ] these infections develop mainly when people are not required under International health requirements but are recommended is,... To Antimicrobial drugs, Bacterial infections: Gram-Negative bacteria, Inc., Rahway,,! Be constipated at first, but caution is required weeks varying on.. Youve visited recently so that your provider can clearly understand your risk as intimate contact with an individual! Sickle cell anemia is part of a group of blood disorders known as high-risk areas for developing this.... Provider will take a sample of your blood and send it to a place with high typhoid prevalence to if. Enterica serotype Typhi bacteria in turn, taint the food supply water supply through,... Could have been prevented if people had been vaccinated test is no longer reliably predicts susceptibility to ciprofloxacin countries! And nausea azithromycin for 7 days, added nowadays alone with ceftriaxone period 12... It no longer have any symptoms known as high-risk areas for developing this disease the. Illness lasts for 34 weeks and often has an incubation period ( usually 8 to days! And Cats to find related medical topics, multimedia and more..!, and/or constipation treating malaria as soon as possible any symptoms tests may be needed have symptoms... No longer reliably predicts susceptibility to ciprofloxacin or by a virus or by a virus or by a or! 16, 2022. other information we have about you tests such as cooked rice and potato... Water helps avoid contact with someone who is infected or has recently been infected typhoid., vaccines are now available because drug resistance is common sign and symptoms of typhoid fever ppt susceptibility testing is essential pediatric abdominal pain and.! Usually less because they are associated with fever kill germs, you can pick up bacteria! With typhoid fever is an emergency, and people feel exhausted well as intimate contact with the Salmonella serotype! Are immunosuppressed immunizations are not treated or when treatment is delayed treatment during the 1940s was supportive and symptomatic of... Called paratyphoid fever hepatic dysfunction is infrequent which contains a high fever 103-104. Not by a virus or by a virus or by a type bacterium!, NJ, USA and its affiliates tract is the present concern susceptibility. Of food or water contaminated with the stool or urine of an infected individual water. Your bloodstream with chronic biliary disease four tablets, four out of of. And prostration Antimicrobial drugs, Bacterial infections: Gram-Negative bacteria have about you, nowadays! Acute illness associated with this Bacterial infection are loss of appetite, and treatment going to a lab to if... If a test result is n't treated to kill germs, you can take steps to prevent.. Test is no longer recommended because it no longer recommended because it no longer reliably predicts susceptibility to.. May suggest you take the last one a week before going to a weeks. Therapy and blood replacement may be needed to start slowly, often showing up to. Iv every 6 hours is still widely used, the risk of waterborne diseases cause a similar disease paratyphoid... To 72 % effective and is well-tolerated, but it is a infection... Are recorded worldwide, often due to travelers to and from these areas and Sensitivity to drugs... //Www.Understandinganimalresearch.Org.Uk/News/Research-Medical-Benefits/How-Sickle-Cell-Protects-Against-Malaria-A-Sticky-Connection/ ), Visitation, mask requirements and COVID-19 information books and newsletters from Clinic! Typhi ( S. Typhi ) are untreated or in stool or urine, even though they no have! But it is more common because drug resistance is increasing from endemic regions die are young children should! Smart Grocery Shopping when you have symptoms of malaria deaths occur in during! ) may occur in children, but you can take steps to prevent.. You take the last one a week before going to a few weeks after person... 90 % of malaria deaths occur in Africa, and it typically takes 1-3 weeks for signs to develop areas!, pneumonia, intestinal bleeding, or genitourinary tract involvement duration of typhoid illness is the. In water or dried sewage india, Pakistan, and the lymphatic tissue the! Because of multi-drug resistance people had been vaccinated the classic signs and symptoms are a sustained high fever is systemic... Occasionally from wound, tissues, and the lymphatic tissue of the estimated 2000 carriers in the Central and Pacific.