Typhoid Fever

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi.  In the United States about 400 cases occur each year, and 75% of these are acquired while traveling internationally.  Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.

Typhoid fever can be prevented and can usually be treated with antibiotics. 

Salmonella Typhi lives only in humans.  Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract.  In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria.  Both ill persons and carriers shed S. Typhi in their stool.

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

Only S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream.  The body reacts with fever and other signs and symptoms.

Typhoid fever is common in most parts of the world except in industrialized regions such as the United States, Canada, western Europe, Australia, and Japan.  Therefore, if you are traveling to the developing world, you should consider taking precautions.  Over the past 10 years, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.

Two basic actions can protect you from typhoid fever:

• Avoid risky foods and drinks
• Get vaccinated against typhoid fever.

Watching what you eat and drink when you travel is as important as being vaccinated.  This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.

Even if your symptoms seem to go away, you may still be carrying S. Typhi. If so, the illness could return, or you could pass the disease to other people.  In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.

Treatment consists of taking the prescribed antibiotics for as long as the doctor has asked you to take them.  Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food to other people.  Have your doctor perform a series of stool cultures to ensure that no S. Typhi bacteria remain in your body.

Reference: www.cdc.gov

For the most current updates about typhoid fever visit: www.nc.cdc.gov/travel/content/diseases.aspx#typhoid

Emergence of a New Antibiotic Resistant Organism

Tourist seeking treatment in India, Pakistan, and the UK are bringing home a dangerous type of bacterial infection that is resistant to nearly all antibiotics, according to an article released today in The Lancet (www.lancet.com).  Doctors have identified 29 patients in the United Kingdom (UK) with this new resistant bacteria.  Most of the individuals have traveled to India, Pakistan or Bangladesh for medical procedures, which included cosmetic surgery.  Dozens of patients from Asia have also gotten infected according to the researchers from Cardiff University.  Most of the new infections involved two common bacteria, E. coli or Klebsiella pneumoniae.  In these cases the bacteria aquired a gene that made it resistant to all but one or two known antibiotics.  The gene is named NDM-1 which protects the bacteria by producing an enzyme that destroys the antibiotics.  NDM-1 was first identified last year but researchers have found some cases dating back to 2003.

NDM-1 is resistant to antibiotics that medical professional consider a “last resort” drug against resistance, they are susceptible to colistin, and tigecycline.  Colistin has not been used much since the 1970s because of toxic side effects.  The new strains appear to be widespread in many medical centers in south Asia and have been seen in Canada, Australia, the Netherlands, Sweden and the United States.  CDC identified three cases in June among patients who were infected with bacteria carrying the NDM-1 gene.  All of the infected patients had undergone surgery in India.

The CDC alerted doctors to the possibility of resistant infections in any patient who had received medical treatment in Pakistan or India.  The CDC also recommended that if patients were identified they should be isolated and physicians and nurses should take extra precautions and wear personal protective equipment including fluid resistant gowns and gloves in combination with Standard Precautions.

Although there are only a few cases identified the fact that the new gene is found in different kinds of bacteria is very troubling.  This gives the NDM-1 gene the potential to spread more quickly and more widely than if it were found in only one bacteria.

Researchers have identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.

The potential of New Delhi Metallo-ß-lactamase 1 (NDM-1) to be a worldwide public health problem is great, and international surveillance is needed.