Typhoid Fever

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Abstract
Typhoid fever is a systemic infection with the bacterium Salmonella enterica serotype typhi. This highly adapted, human-specific pathogen has evolved remarkable mechanisms for persistence in its host that help to ensure its survival and transmission. Typhoid fever was an important cause of illness and death in the overcrowded and unsanitary urban conditions of the United States and Europe in the 19th century.1 The provision of clean water and good sewage systems led to a dramatic decrease in the incidence of typhoid in these regions. Today most of the burden of the disease occurs in the developing world, where sanitary conditions remain poor. Reliable data from which to estimate the burden of disease in these areas are difficult to obtain, since many hospitals lack facilities for blood culture and up to 90 percent of patients with typhoid are treated as outpatients. Community-based studies have consistently shown higher levels of typhoid than public health figures suggest. Annual incidence rates of 198 per 100,000 in the Mekong Delta region of Vietnam2 and 980 per 100,000 in Delhi, India,3 have recently been reported. According to the best global estimates, there are at least 16 million new cases of typhoid fever each year, with 600,000 deaths.4 The introduction of chloramphenicol for the treatment of typhoid fever in 1948 transformed a severe, debilitating, and often fatal disease into a readily treatable condition.5 The emergence of resistance to chloramphenicol and other antimicrobial agents has been a major setback.6 We now face the very real prospect that untreatable typhoid fever will reemerge.