Typhoid fever

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Abstract
Typhoid fever is caused by infection with Salmonella enterica serovar Typhi. The completion of the genome sequence of two Salmonella enterica serovar Typhi isolates is leading to new insights into the biology of this pathogen. Approximately 16 million cases occur worldwide each year. The lack of culture facilities in endemic areas and the poor performance of the Widal test means the disease is frequently unconfirmed. Simple new serologic tests are being developed and show promise. Resistance to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole is widespread in Asia and some areas of Africa, although fully susceptible isolates have re-emerged in some countries. Fluoroquinolones, third-generation cephalosporins, and azithromycin are effective alternatives. Low-level fluoroquinolone resistance (indicated by resistance to nalidixic acid) is now common in Asia and results in a suboptimal response to fluoroquinolones. Two vaccines are licensed and others are being developed, but neither licensed vaccine is used in endemic areas as a public health measure.