eMedicine Specialties > Ophthalmology > Infectious Disease

Typhoid Fever: Follow-up

Author: Theodore Curtis, MD, Assistant Professor of Ophthalmology, University of Colorado; Consulting Staff, Rocky Mountain Lions Eye Institute
Coauthor(s): David T Wheeler, MD, Associate Professor, Departments of Ophthalmology and Pediatrics, Oregon Health & Science University
Contributor Information and Disclosures

Updated: Sep 29, 2006

Follow-up

In/Out Patient Meds:

  • Treatment of ocular infection involves use of topical chloramphenicol or ciprofloxacin, both available as solution or ointment, following sample collection for culture and sensitivity. Frequency of application should correspond with severity of infection.
  • Treatment of uveitis requires use of topical, periocular, or systemic corticosteroids. The mainstay of this treatment for anterior uveitis is topical prednisolone acetate. This often is combined with mydriatic-cycloplegic and analgesic agents.
  • Other ocular conditions, such as serous retinal detachment, optic neuritis, and cranial neuropathies, are presumed to be due to immune factors. Treatment is directed toward the underlying infection and resultant inflammation.

Deterrence/Prevention:

  • Improvement of environmental sanitation, including water supplies and sewage disposal, will sharply reduce the incidence of typhoid fever.
  • Travelers to developing countries should avoid consuming untreated water, drinks served with ice, peeled fruits, and other food not served hot. Ice cream, unwashed produce, and shellfish are frequently reported causes of outbreaks of typhoid fever.
  • Several vaccines are available and are effective in decreasing the risk of disease by 50-75%. However, persons who have been vaccinated should still exercise dietary precautions.

Complications:

  • The most serious complication, intestinal bleeding or perforation, occurs in about 5% of patients. Bleeding usually is noted after the second week of illness, but perforation may occur unexpectedly after the patient has started to improve.
  • Other complications include pneumonia, myocarditis, acute cholecystitis, and acute meningitis.
  • Studies show that 1-5% of patients become chronic carriers, who harbor S typhi in their gall bladders. The risk of carrier status is correlated to underlying biliary pathology and co-infection with schistosomiasis.

Prognosis:

  • Survival rates exceed 96% in developed countries but remain less than 90% in parts of the developing world despite antibiotic availability.

Patient Education:

  • Observing dietary precautions and proper hygiene are important to patients during travel abroad, especially in high-risk areas.

Miscellaneous

Medicolegal Pitfalls

  • Typhoid fever is a reportable disease in the United States.
 


More on Typhoid Fever

Overview: Typhoid Fever
Differential Diagnoses & Workup: Typhoid Fever
Treatment & Medication: Typhoid Fever
Follow-up: Typhoid Fever
References
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References

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  2. Akalin HE. Quinolones in the treatment of typhoid fever. Drugs. 1999;58 Suppl 2:52-4. [Medline].

  3. Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet. Aug 27-Sep 2 2005;366(9487):749-62. [Medline].

  4. Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. Jul 8 2006;333(7558):78-82. [Medline].

  5. Davis TM, Makepeace AE, Dallimore EA, et al. Relative bradycardia is not a feature of enteric fever in children. Clin Infect Dis. Mar 1999;28(3):582-6. [Medline].

  6. Engels EA, Lau J. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2000;(2):CD001261. [Medline].

  7. Hanel RA, Araujo JC, Antoniuk A, et al. Multiple brain abscesses caused by Salmonella typhi: case report. Surg Neurol. Jan 2000;53(1):86-90. [Medline].

  8. Ismail TF. Rapid diagnosis of typhoid fever. Indian J Med Res. Apr 2006;123(4):489-92. [Medline].

  9. Jong EC. Travel immunizations. Med Clin North Am. Jul 1999;83(4):903-22, vi. [Medline].

  10. Julia J, Canet JJ, Lacasa XM, et al. Spontaneous spleen rupture during typhoid fever. Int J Infect Dis. 2000;4(2):108-9. [Medline].

  11. Khan M, Coovadia YM, Connolly C, et al. Influence of sex on clinical features, laboratory findings, and complications of typhoid fever. Am J Trop Med Hyg. Jul 1999;61(1):41-6. [Medline].

  12. Noyola DE, Fernandez M, Kaplan SL. Reevaluation of antipyretics in children with enteric fever. Pediatr Infect Dis J. Aug 1998;17(8):691-5. [Medline].

  13. Parry CM, Hien TT, Dougan G. Typhoid fever. N Engl J Med. Nov 28 2002;347(22):1770-82. [Medline].

  14. Thomsen LL, Paerregaard A. Treatment with ciprofloxacin in children with typhoid fever. Scand J Infect Dis. 1998;30(4):355-7. [Medline].

  15. World Health Organization. Background document: the diagnosis, treatment, and prevention of typhoid fever. Geneva, Switzerland: 2003.

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Further Reading

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Keywords

enteric fever, Salmonella typhi

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Contributor Information and Disclosures

Author

Theodore Curtis, MD, Assistant Professor of Ophthalmology, University of Colorado; Consulting Staff, Rocky Mountain Lions Eye Institute
Theodore Curtis, MD is a member of the following medical societies: American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus
Disclosure: Nothing to disclose.

Coauthor(s)

David T Wheeler, MD, Associate Professor, Departments of Ophthalmology and Pediatrics, Oregon Health & Science University
David T Wheeler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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