Typhoid Fever: Recent Advances in Understanding, Diagnosis, and Management Strategies for Endemic Regions
Tufael 1*, Atiqur Rahman Sunny 2
Journal of Primeasia 1(1) 1-8 https://doi.org/10.25163/primeasia.119803
Submitted: 19 October 2020 Revised: 21 December 2020 Published: 28 December 2020
Abstract
Typhoid fever, caused by Salmonella enterica serotype Typhi, remains a significant public health challenge in developing countries despite major declines in incidence in the Western world. Historically, typhoid fever was a major cause of morbidity and mortality in Europe and the United States, primarily due to poor sanitation and inadequate water supply. Advances in public health infrastructure have markedly reduced its prevalence in developed regions, but it continues to affect millions annually in parts of Asia, including Bangladesh. The disease disproportionately impacts children and persists in areas with suboptimal sanitation and overcrowded living conditions. In Bangladesh, inadequate data on typhoid fever burden complicates effective management and control. Challenges include the prevalence of outpatients, insufficient diagnostic facilities, unreliable record-keeping, and limitations of the Widal test, which has moderate sensitivity and specificity. This review aims to consolidate recent advancements in understanding typhoid fever, particularly within the Indian context, by examining its epidemiology, pathogenesis, symptomatology, diagnostic methods, and treatment strategies. Notable epidemiological trends reveal high incidence rates in South Asia, with significant seasonal variation. Improved diagnostic tools, such as PCR and newer serological tests, are emerging, but blood culture remains the gold standard. Treatment has evolved with concerns over drug resistance, and prevention strategies emphasize the importance of improved sanitation and water safety. This review highlights the need for enhanced public health efforts and research to address the persistent challenges of typhoid fever in endemic regions.
Keywords: Typhoid Fever, Salmonella Typhi, Epidemiology, Diagnostic Methods, Antimicrobial Resistance.
References
Acharya, I. L., Lowe, C. U., Thapa, R., Gurubacharya, V. L., Shrestha, M. B., & Cadoz, M., et al. (1987). Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi: A preliminary report. New England Journal of Medicine, 317, 1101-1104.
Ahasan, H. A., Rafiqueddin, A. K. M., Chowdhury, M. A. J., Azad, K. A. K., Karim, M. E., & Hussain, A. (1993). An unusual presentation of typhoid fever:
Barza, M., & Travers, K. (2002). Excess infections due to antimicrobial resistance: The “Attributable Fraction.” Clinical Infectious Diseases, 34(3), S126–S130.
Bhan, M. K., Bahl, R., & Sazawal, S. (2002). Association between Helicobacter pylori infection and increased risk of typhoid fever. Journal of Infectious Diseases, 186(12), 1857–1860.
Bhutta, Z. A. (2006). Current concepts in the diagnosis and treatment of typhoid fever. BMJ, 333(7558), 78–82.
Black, R. E., Levine, M. M., Ferreccio, C., Clements, M. L., Lanata, C., Rooney, J., et al. (1990). Efficacy of one or two doses of Ty21a Salmonella typhi vaccine in enteric-coated capsules in a controlled field trial. Chilean Typhoid Committee, 8, 81-84.
Breiman, R. F., Cosmas, L., Njuguna, H., Audi, A., Olack, B., Ochieng, J. B., et al. (2012). Population-based incidence of typhoid fever in an urban informal settlement and a rural area in Kenya: Implications for typhoid vaccine use in Africa. PLOS ONE, 7(1), e29119.
Brooks, W. A., Hossain, A., Goswami, D., Nahar, K., Alam, K., & Ahmed, N., et al. (2005). Bactaeremic typhoid fever in children in an urban slum, Bangladesh. Emerging Infectious Diseases, 11, 326-329.
Centers for Disease Control and Prevention. (2010). Summary of notifiable diseases—United States, 2008. Morbidity and Mortality Weekly Report, 57(53), 94.
Chen, X., Stanton, B., Pach, A., Nyamete, A., Ochiai, R. L., & Kaljee, L., et al. (2007). Adults' perceived prevalence of enteric fever predicts laboratory-validated incidence of typhoid fever in children. Journal of Health, Population and Nutrition, 25, 469-478.
Committee on Issues and Priorities for New Vaccine Development, Division of Health Promotion and Disease Prevention, Division of International Health. (1986). New vaccine development: Establishing priorities: Diseases of importance in developing countries (p. 432). Washington, DC: National Academy Press.
Crump, J. A., & Mintz, E. D. (2010). Global trends in typhoid and paratyphoid fever. Clinical Infectious Diseases, 50(2), 241–246.
Crump, J. A., Luby, S. P., & Mintz, E. D. (2004). The global burden of typhoid fever. Bulletin of the World Health Organization, 82, 346-353.
Crump, J. A., Youssef, F. G., Luby, S. P., Wasfy, M. O., Rangel, J. M., & Taalat, M., et al. (2003). Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerging Infectious Diseases, 9, 539-544.
Dharmana, E., Joosten, I., Tijssen, H. J., & Duggirala, V. (2002). HLA-DRB1*12 is associated with protection against complicated typhoid fever, independent of tumor necrosis factor alpha. European Journal of Immunogenetics, 29(3), 297–300.
Dore, K., Baxton, J., Henry, B., Pollari, F., Middleton, D., Fyfe, M., et al. (2004). Risk factors for Salmonella typhimurium DT 104 and non-DT 104 infection: A Canadian multi-provincial case-control study. Epidemiology & Infection, 132(4), 485–493.
Dunn, J., Pryor, J., Saketa, S., Wasale, D., Buadromo, E., Kishore, K., et al. (2005). Laboratory-based Salmonella surveillance in Fiji, 2004–2005. Pacific Health Dialog, 12(1), 53–59.
Dunstan, S. J., Stephens, H. A., Blackwell, J. M., Duc, C. M., Lanh, M. N., Hien, T. T., et al. (2001). Genes of the class II and class III major histocompatibility complex are associated with typhoid fever in Vietnam. Journal of Infectious Diseases, 183(2), 261–268.
Edelman, R., & Levine, M. M. (1986). Summary of an international workshop on typhoid fever. Reviews of Infectious Diseases, 8, 329-349.
European Centre for Disease Prevention and Control (ECDC). (2011). The European Surveillance System (TESSy). Stockholm, SE: ECDC.
Everest, P., Wain, J., Roberts, M., Rook, G., & Dougan, G. (2001). The molecular mechanisms of severe typhoid fever. Trends in Microbiology, 9(7), 316–320.
Gilman, R. H., Terminel, M., Levine, M. M., Hernandez-Mendoza, P., & Hornick, R. B. (1975). Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. Lancet, 1, 1211-1213.
Glynn, M. K., Reddy, V., Hutwagner, L., Shiferaw, B., Angulo, F. J., & The FoodNet Working Group. (2008). Prior antimicrobial agent use increases the risk of sporadic infections with multidrug-resistant Salmonella enterica serotype Typhimurium: A FoodNet case-control study. Clinical Infectious Diseases, 38(3), S227–S236.
Hoffman, S. L., Edman, D. C., Punjabi, N. H., Lesmana, M., Cholid, A., Sundah, S., et al. (1986). Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml (1:10) blood-to-broth ratio blood culture for diagnosis of typhoid fever. American Journal of Tropical Medicine and Hygiene, 35, 836-839.
Hornick, R. B., Greisman, S. E., Woodward, T. E., DuPont, H. L., Dawkins, A. T., & Snyder, M. J. (1970). Typhoid fever: Pathogenesis and immunologic control. New England Journal of Medicine, 283(13), 686–691, and 283(14), 739–746.
Hosoglu, S., Celen, M., Geyik, M. F., Akalin, S., Ayaz, C., & Kokoglu, O. F. (2006). Risk factors for typhoid fever among adult patients in Diyarbakir, Turkey. Epidemiology & Infection, 134(3), 612–616.
House, D., Bishop, A., Parry, C., Dougan, G., & Wain, J. (2001). Typhoid fever: Pathogenesis and disease. Current Opinion in Infectious Diseases, 14(5), 573–578.
Infectious Disease Surveillance Centre. (2009). Infectious Agents Surveillance Report: Typhoid fever and paratyphoid fever in Japan. Retrieved from http://idsc.nih.go.jp/iasr/index.html
Institute for Health Metrics and Evaluation. (2012). Global burden of disease study [Internet]. Seattle, WA: Institute for Health Metrics and Evaluation. Available at: http://www.globalburden.org/. (Accessed: 3 March 2012).
Institute of Environmental Science and Research Limited, Population and Environmental Health Group. (2010). Notifiable and other diseases in New Zealand: 2009 annual surveillance report. Porirua, NZ: Institute of Environmental Science and Research Limited.
Khan, M. I., Sahito, S. M., Khan, M. J., Wassan, S. M., Shaikh, A. W., & Maheshwari, A. K., et al. (2006). Enhanced disease surveillance through private health care sector cooperation in Karachi, Pakistan: Experience from a vaccine trial. Bulletin of the World Health Organization, 84, 72-77.
Klugman, K. P., Gilbertson, I. T., Koornhof, H. J., Robbins, J. B., Schneerson, R., & Schulz, D., et al. (1987). Protective activity of Vi capsular polysaccharide vaccine against typhoid fever. Lancet, 2, 1165-1169.
Kothari, A., Pruthi, A., & Chugh, T. D. (2008). The burden of enteric fever. Journal of Infection in Developing Countries, 2, 253-259.
Levine, M. M., Ferreccio, C., Black, R. E., & Germanier, R. (1987). Large-scale field trial of Ty21a live oral typhoid vaccine in enteric-coated capsule formulation. Lancet, 1, 1049-1052.
Levine, M. M., Ferreccio, C., Cryz, S., & Ortiz, E. (1990). Comparison of enteric-coated capsules and liquid formulation of Ty21a typhoid vaccine in randomized controlled field trial. Lancet, 336, 891-894.
Lin, F. Y., Ho, V. A., Khiem, H. B., Trach, D. D., Bay, P. V., Thanh, T. C., et al. (2001). The efficacies of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. New England Journal of Medicine, 344(17), 1263–1269.
Lin, F. Y., Vo, A. H., Phan, V. B., Nguyen, T. T., Bryla, D., Tran, C. T., et al. (2000). The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam. American Journal of Tropical Medicine and Hygiene, 62(5), 644–648.
Lutui, T., Ofanoa, M., Finau, S., & Maika, K. V. (1999). Typhoid fever in Tonga. Pacific Health Dialog, 6(2), 240–244.
Lynch, M. F., Blanton, E. M., Bulens, S., Polyak, C., Vojdani, J., Stevenson, J., ... & Mintz, E. D. (2009). Typhoid fever in the United States, 1999-2006. Jama, 302(8), 859-865.
Murray, C. J. L., & Lopez, A. D. (1996). Global burden of disease and injury series (1st ed., p. 1). Boston, MA: Harvard University Press.
Ochiai, R. L., Acosta, C. J., Danovaro-Holliday, M. C., Baiqing, D., Bhattacharya, S. K., & Agtini, M. D., et al. (2008). A study of typhoid fever in five Asian countries: Disease burden and implications for controls. Bulletin of the World Health Organization, 86, 260-268.
Ochiai, R. L., Wang, X., von Seidlein, L., Yang, J., Bhutta, Z. A., & Bhattacharya, S. K., et al. (2005). Salmonella para typhi A rates, Asia. Emerging Infectious Diseases, 11, 1764-1766.
Parry, C. M., Hien, T. T., Dougan, G., White, N. J., & Farrar, J. J. (2002). Typhoid fever. New England Journal of Medicine, 347(22), 1770–1782.
Pavia, A. T., Shipman, L. D., Wells, J. G., Puhr, N. D., Smith, J. D., McKinley, T. W., et al. (1990). Epidemiologic evidence that prior antimicrobial exposure decreases resistance to infection by antimicrobial-sensitive Salmonella. Journal of Infectious Diseases, 161(2), 255–260.
Ram, P. K., Naheed, A., Brooks, W. A., Hossain, A., Mintz, E. D., & Breiman, R. F. (2007). Risk factors for typhoid fever in a slum in Dhaka, Bangladesh. Epidemiology & Infection, 135(3), 458–465.
Siddiqui, F. J., Rabbani, F., Hasan, R., Nizami, S. Q., & Bhutta, Z. A. (2006). Typhoid fever in children: Some epidemiological considerations from Karachi, Pakistan. International Journal of Infectious Diseases, 10, 215-222.
Simanjuntak, C. H., Paleologo, F. P., Punjabi, N. H., Darmowigoto, R., Soeprawoto, T., Totosudirjo, H., et al. (1991). Oral immunization against typhoid fever in Indonesia with Ty21a vaccine. The Lancet, 338(8774), 1055–1059.
Sinha, A., Sazawal, S., Kumar, R., Sood, S., Reddaiah, V. P., & Singh, B., et al. (1999). Typhoid fever in children aged less than 5 years. Lancet, 354, 734-737.
Srikantiah, P., Girgis, F. Y., Luby, S. P., Jennings, G., Wasfy, M. O., & Crump, J. A., et al. (2006). Population-based surveillance of typhoid fever in Egypt. American Journal of Tropical Medicine and Hygiene, 74, 114-119.
Srikantiah, P., Vafokulov, S., Luby, S. P., Kasymbekov, Y., Mullodzhanov, R., & Reyburn, R. (2007). Epidemiology and risk factors for endemic typhoid fever in Uzbekistan. Tropical Medicine & International Health, 12(7), 838–847.
Stuart, B. M., & Pullen, R. L. (1946). Typhoid: Clinical analysis of 360 cases. Archives of Internal Medicine (Chic), 78, 629-661.
Sur, D., Ali, M., von Seidlein, L., Manna, B., Deen, J. L., & Acosta, C. J., et al. (2007). Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India. BMC Public Health, 7, 289.
Sur, D., Ochiai, R. L., Bhattacharya, S. K., Ganguly, N. K., Ali, M., & Manna, B., et al. (2009). A cluster-randomized effectiveness trial of Vi typhoid vaccine in India. New England Journal of Medicine, 361, 335-344.
The OzFoodNet Working Group. (2010). Monitoring the incidence and causes of diseases potentially transmitted by food in Australia: Annual report of the OzFoodNet Network, 2009. Communicable Diseases Intelligence, 34(4), 396–426.
Vollaard, A. M., Ali, S., & Van Asten, H. A. G. H. (2004). Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA, 291(21), 2607–2615.
Vollaard, A. M., Ali, S., Widjaja, S., Van Asten, H. A., Visser, L. G., Surjadi, C., et al. (2005). Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia. Transactions of the Royal Society of Tropical Medicine and Hygiene, 99(6), 440–450.
Wahdan, M. H., Serie, C., Cerisier, Y., Sallam, S., & Germanier, R. (1982). A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: Three-year results. Journal of Infectious Diseases, 145, 292-295.
World Health Organization. (2003). Background document: The diagnosis, treatment, and prevention of typhoid fever. Geneva, Switzerland: World Health Organization.
Yang, H. H., Wu, C. G., Xie, G. Z., Gu, Q. W., Wang, B. R., & Wang, L. Y., et al. (2001). Efficacy trial of Vi polysaccharide vaccine against typhoid fever in south-western China. Bulletin of the World Health Organization, 79, 625-631.
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