Typhoid fever

Typhoid fever

Overview
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

 of an infected person, which contain the bacterium Salmonella enterica
Salmonella enterica
Salmonella enterica is a rod-shaped flagellated, facultative anaerobic, Gram-negative bacterium, and a member of the genus Salmonella.- Epidemiology :...

, serovar Typhi. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages.
The
organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella
Flagellum
A flagellum is a tail-like projection that protrudes from the cell body of certain prokaryotic and eukaryotic cells, and plays the dual role of locomotion and sense organ, being sensitive to chemicals and temperatures outside the cell. There are some notable differences between prokaryotic and...

.
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Encyclopedia
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

 of an infected person, which contain the bacterium Salmonella enterica
Salmonella enterica
Salmonella enterica is a rod-shaped flagellated, facultative anaerobic, Gram-negative bacterium, and a member of the genus Salmonella.- Epidemiology :...

, serovar Typhi. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages.
The
organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella
Flagellum
A flagellum is a tail-like projection that protrudes from the cell body of certain prokaryotic and eukaryotic cells, and plays the dual role of locomotion and sense organ, being sensitive to chemicals and temperatures outside the cell. There are some notable differences between prokaryotic and...

. The bacterium grows best at 37°C / 98.6°F – human body temperature.

This fever received various names, such as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, pythogenic fever, etc. The name of "typhoid" comes from the neuropsychiatric symptoms common to typhoid and typhus
Typhus
Epidemic typhus is a form of typhus so named because the disease often causes epidemics following wars and natural disasters...

  (from Greek τῦϕος, "stupor").

The impact of this disease fell sharply with the application of modern sanitation techniques.

Signs and symptoms


Typhoid fever is characterized by a slowly progressive fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

 as high as 40 °C (104 °F), profuse sweating and gastroenteritis
Gastroenteritis
Gastroenteritis is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water...

. Less commonly, a rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...

 of flat, rose-colored spots may appear.

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

, malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...

, headache, and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia
Leukopenia
Leukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection....

, a decrease in the number of circulating white blood cells, with eosinopenia
Eosinopenia
Eosinopenia is a form of agranulocytosis where the number of eosinophil granulocyte is lower than expected.Leukocytosis with eosinopenia can be a predictor of bacterial infection....

 and relative lymphocytosis
Lymphocytosis
Lymphocytosis is an increase in the number or proportion of lymphocytes in the blood, usually detected when a complete blood count is routinely obtained. Lymphocytes normally represent 20 to 40% of circulating white blood cells...

, a positive reaction and blood cultures are positive for Salmonella
Salmonella
Salmonella is a genus of rod-shaped, Gram-negative, non-spore-forming, predominantly motile enterobacteria with diameters around 0.7 to 1.5 µm, lengths from 2 to 5 µm, and flagella which grade in all directions . They are chemoorganotrophs, obtaining their energy from oxidation and reduction...

 typhi
or paratyphi. The classic Widal test
Widal test
Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. It is a presumptive serological test for enteric fever or undulant fever. In case of Salmonella infections, it is a demonstration of the presence of O-soma...

 is negative in the first week.

In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

 (sphygmothermic dissociation), classically with a dicrotic pulse
Dicrotic pulse
A dicrotic pulse is a type of pulse characterized by a percussion wave in systole and a prominent dicrotic wave in diastole. Physiologically, the dicrotic wave is the result of reflected waves from the lower extremities and aorta....

 wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

 gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. There are rhonchi
Rhonchi
Rhonchi is the coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Rhonchi is the plural form of the singular word rhonchus.-Description:...

 in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly
Hepatosplenomegaly
Hepatosplenomegaly is the simultaneous enlargement of both the liver and the spleen . Hepatosplenomegaly can occur as the result of acute viral hepatitis or infectious mononucleosis, or it can be the sign of a serious and life threatening lysosomal storage disease...

) and tender, and there is elevation of liver transaminases. The Widal
Georges-Fernand Widal
Georges-Fernand-Isidor Widal; was a French physician.From 1886 to 1888 he devoted himself to public demonstrations of the researches of the faculty of pathological anatomy, and during the 2 years following was in charge of a course in bacteriology in the laboratory of Professor Victor André Cornil...

 reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage.
(The major symptom of this fever is that the fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

 usually rises in the afternoon up to the first and second week.)

In the third week of typhoid fever, a number of complications can occur:
  • Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal.
  • Intestinal perforation in the distal ileum
    Ileum
    The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...

    : this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis
    Peritonitis
    Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...

     sets in.
  • Encephalitis
    Encephalitis
    Encephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...

  • Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects.
  • Metastatic abscesses, cholecystitis
    Cholecystitis
    -Signs and symptoms:Cholecystitis usually presents as a pain in the right upper quadrant. This is known as biliary colic. This is initially intermittent, but later usually presents as a constant, severe pain. During the initial stages, the pain may be felt in an area totally separate from the site...

    , endocarditis
    Endocarditis
    Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...

     and osteitis
    Osteitis
    Osteitis is a general term for inflammation of bone. More specifically, it can refer to one of the following conditions:* Alveolar osteitis or "dry socket"* Condensing osteitis * Osteitis deformans...


The fever is still very high and oscillates very little over 24 hours. Dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...

 ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing this (defervescence). This carries on into the fourth and final week.
has bunch of red spots around the surface of body.

Transmission


The bacteria which causes typhoid fever may be spread through poor hygiene habits and public sanitation conditions, and sometimes also by flying insects feeding on feces. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. According to statistics from the United States Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

 (CDC), the chlorination
Chlorination
Chlorination is the process of adding the element chlorine to water as a method of water purification to make it fit for human consumption as drinking water...

 of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S.A.

A person may become an asymptomatic carrier
Asymptomatic carrier
An asymptomatic carrier is a person or other organism that has contracted an infectious disease, but who displays no symptoms. Although unaffected by the disease themselves, carriers can transmit it to others...

 of typhoid fever, suffering no symptoms, but capable of infecting others. According to the CDC approximately 5% of people who contract typhoid continue to carry the disease after they recover. The most famous asymptomatic carrier was Mary Mallon (commonly known as "Typhoid Mary"), a young cook who was responsible for infecting at least 53 people with typhoid, three of whom died from the disease. Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic".

Many carriers of typhoid were locked into an isolation ward never to be released in order to prevent further typhoid cases. These people often deteriorated mentally, driven mad by the conditions they lived in.

Possible protective effects of heterozygosity for cystic fibrosis


It has been hypothesized that cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...

 may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. The CFTR protein
Cystic fibrosis transmembrane conductance regulator
Cystic fibrosis transmembrane conductance regulator is a protein that in humans is encoded by the CFTR gene.CFTR is a ABC transporter-class ion channel that transports chloride and thiocyanate ions across epithelial cell membranes...

 is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium. However, the heterozygous advantage hypothesis was proposed in one review in which the author himself writes, "Although cellular/molecular evidence presently is not available for this hypothesis, the CF mutation may be one of several mutations that have spread in European populations because they increased resistance to infectious diseases." Since no molecular experimental evidence has been presented in support of this theory, this theory is not accepted by the majority of the scientific community.
'

Diagnosis of typhoid


Diagnosis is made by any blood
Blood culture
Blood culture is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream...

, bone marrow
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...

 or stool
Human feces
Human feces , also known as a stool, is the waste product of the human digestive system including bacteria. It varies significantly in appearance, according to the state of the digestive system, diet and general health....

 culture
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...

s and with the Widal test
Widal test
Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. It is a presumptive serological test for enteric fever or undulant fever. In case of Salmonella infections, it is a demonstration of the presence of O-soma...

 (demonstration of salmonella antibodies
Antibody
An antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...

 against antigens O-somatic and H-flagellar). In epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

s and less wealthy countries, after excluding malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

, dysentery
Dysentery
Dysentery is an inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing mucus and/or blood in the faeces with fever and abdominal pain. If left untreated, dysentery can be fatal.There are differences between dysentery and normal bloody diarrhoea...

 or pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

, a therapeutic trial time with chloramphenicol
Chloramphenicol
Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

 is generally undertaken while awaiting the results of Widal test
Widal test
Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. It is a presumptive serological test for enteric fever or undulant fever. In case of Salmonella infections, it is a demonstration of the presence of O-soma...

 and cultures of the blood and stool.

The Widal test
Widal test
Test whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. It is a presumptive serological test for enteric fever or undulant fever. In case of Salmonella infections, it is a demonstration of the presence of O-soma...

 is time consuming and oftentimes when diagnosis is reached it is too late to start an antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

 regimen.

The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.

Prevention



Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals and therefore transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to preventing typhoid.

There are two vaccines licensed for use for the prevention of typhoid: the live, oral Ty21a
Ty21a
Ty21a is a live attenuated bacterial vaccine that protects against typhoid. It is one of two typhoid vaccines currently recommended by the World Health Organization. The vaccine offers a statistically significant protection for the first three years, with between 8% to 54% effectiveness for the...

 vaccine (sold as Vivotif Berna) and the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline). Both are between 50% to 80% protective and are recommended for travellers to areas where typhoid is endemic. Boosters are recommended every 5 years for the oral vaccine and every 2 years for the injectable form. There exists an older killed whole-cell vaccine that is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use, because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection).

Treatment


The rediscovery of oral rehydration therapy
Oral rehydration therapy
Oral rehydration therapy is a simple treatment for dehydration associated with diarrhoea, particularly gastroenteritis or gastroenteropathy, such as that caused by cholera or rotavirus. ORT consists of a solution of salts and sugars which is taken by mouth...

 in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general.


Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin
Ciprofloxacin
Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...

 otherwise, a third-generation cephalosporin such as ceftriaxone
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy...

 or cefotaxime
Cefotaxime
Cefotaxime is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram positive and Gram negative bacteria...

 is the first choice. Cefixime
Cefixime
Cefixime is an oral third generation cephalosporin antibiotic. Cefixime is a cephalosporin antibiotic used to treat infections caused by bacteria such as pneumonia; bronchitis; gonorrhea; and ear, lung, throat, and urinary tract infections...

 is a suitable oral alternative.

Typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin
Ampicillin
Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. Until the introduction of ampicillin by the British company Beecham, penicillin therapies had only been effective against Gram-positive organisms such as staphylococci and streptococci...

, chloramphenicol
Chloramphenicol
Chloramphenicol is a bacteriostatic antimicrobial that became available in 1949. It is considered a prototypical broad-spectrum antibiotic, alongside the tetracyclines, and as it is both cheap and easy to manufacture it is frequently found as a drug of choice in the third world.Chloramphenicol is...

, trimethoprim-sulfamethoxazole, amoxicillin
Amoxicillin
Amoxicillin , formerly amoxycillin , and abbreviated amox, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral...

 and ciprofloxacin
Ciprofloxacin
Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...

, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. In some communities, however, case-fatality rates may reach as high as 47%.

Resistance


Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole and streptomycin
Streptomycin
Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...

 is now common, and these agents have not been used as first line treatment now for almost 20 years. Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).

Ciprofloxacin resistance is an increasing problem, especially in the Indian subcontinent
Indian subcontinent
The Indian subcontinent, also Indian Subcontinent, Indo-Pak Subcontinent or South Asian Subcontinent is a region of the Asian continent on the Indian tectonic plate from the Hindu Kush or Hindu Koh, Himalayas and including the Kuen Lun and Karakoram ranges, forming a land mass which extends...

 and Southeast Asia
Southeast Asia
Southeast Asia, South-East Asia, South East Asia or Southeastern Asia is a subregion of Asia, consisting of the countries that are geographically south of China, east of India, west of New Guinea and north of Australia. The region lies on the intersection of geological plates, with heavy seismic...

. Many centres are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in South America, India, Pakistan, Bangladesh, Thailand or Vietnam. For these patients, the recommended first line treatment is ceftriaxone. It has also been suggested azithromycin
Azithromycin
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is one of the world's best-selling antibiotics...

 is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. Azithromycin significantly reduces relapse rates compared with ceftriaxone.

There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid
Nalidixic acid
Nalidixic acid is the first of the synthetic quinolone antibiotics...

 (NAL), and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin", but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". However, an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC
Minimum inhibitory concentration
In microbiology, minimum inhibitory concentration is the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation. Minimum inhibitory concentrations are important in diagnostic laboratories to confirm resistance of microorganisms...

 0.125–1.0 mg/l) would not be picked up by this method. It is not certain how this problem can be solved, because most laboratories around the world (including the West) are dependent on disk testing
Kirby-Bauer antibiotic testing
Kirby-Bauer antibiotic testing is a test which uses antibiotic-impregnated wafers to test whether particular bacteria are susceptible to specific antibiotics. A known quantity of bacteria are grown on agar plates in the presence of thin wafers containing relevant antibiotics...

 and cannot test for MICs.

Epidemiology


With an estimated 16–33 million cases of annually resulting in 216,000 deaths in endemic areas, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 identifies typhoid as a serious public health problem. Its incidence is highest in children and young adults between 5 and 19 years old.

History


Around 430–424 BC, a devastating plague
Pandemic
A pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic...

, which some believe to have been typhoid fever, killed one third of the population of Athens
History of Athens
Athens is one of the oldest named cities in the world, having been continuously inhabited for at least 7000 years. Situated in southern Europe, Athens became the leading city of Ancient Greece in the first millennium BCE and its cultural achievements during the 5th century BCE laid the foundations...

, including their leader Pericles
Pericles
Pericles was a prominent and influential statesman, orator, and general of Athens during the city's Golden Age—specifically, the time between the Persian and Peloponnesian wars...

. The balance of power shifted from Athens to Sparta
Sparta
Sparta or Lacedaemon, was a prominent city-state in ancient Greece, situated on the banks of the River Eurotas in Laconia, in south-eastern Peloponnese. It emerged as a political entity around the 10th century BC, when the invading Dorians subjugated the local, non-Dorian population. From c...

, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides
Thucydides
Thucydides was a Greek historian and author from Alimos. His History of the Peloponnesian War recounts the 5th century BC war between Sparta and Athens to the year 411 BC...

 also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak and modern academics and medical scientists consider epidemic typhus the most likely cause; a 2006 study detected DNA
DNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...

 sequences similar to those of the bacterium responsible for typhoid fever. However the cause of the plague has long been disputed and other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of Attica
Attica
Attica is a historical region of Greece, containing Athens, the current capital of Greece. The historical region is centered on the Attic peninsula, which projects into the Aegean Sea...

 was besieged within the Long Walls
Long Walls
The Long Walls , in Ancient Greece, were walls built from a city to its port, providing a secure connection to the sea even during times of siege. Although long walls were built at several locations in Greece—Corinth and Megara being two of the best known examples—the phrase "long...

 and lived in tents.

Some historians believe that in the English colony of Jamestown, Virginia
Jamestown, Virginia
Jamestown was a settlement in the Colony of Virginia. Established by the Virginia Company of London as "James Fort" on May 14, 1607 , it was the first permanent English settlement in what is now the United States, following several earlier failed attempts, including the Lost Colony of Roanoke...

, typhoid fever killed more than 6000 settlers between 1607 and 1624. During the American Civil War
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...

, 81,360 Union soldiers died of typhoid or dysentery. In the late 19th century, typhoid fever mortality rate in Chicago
Chicago 1885 cholera epidemic myth
The Chicago 1885 cholera epidemic myth is a persistent urban legend, stating that 90,000 people in Chicago died of typhoid fever and cholera in 1885. Although the story is widely reported, these deaths did not occur....

 averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 people. The most notorious carrier of typhoid fever—but by no means the most destructive—was Mary Mallon
Mary Mallon
Mary Mallon , also known as Typhoid Mary, was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever. She was presumed to have infected some 53 people, three of whom died, over the course of her career as a cook...

, also known as Typhoid Mary. In 1907, she became the first American
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 carrier to be identified and traced. She was a cook in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

. She is closely associated with fifty-three cases and three deaths. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job but returned later under a false name
Pseudonym
A pseudonym is a name that a person assumes for a particular purpose and that differs from his or her original orthonym...

. She was detained and quarantine
Quarantine
Quarantine is compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian quarantena, meaning forty-day period....

d after another typhoid outbreak. She died of pneumonia after 26 years in quarantine.

In 1880 Karl Joseph Eberth described a bacillus that he suspected was the cause of typhoid. In 1884 pathologist Georg Theodor August Gaffky (1850–1918) confirmed Eberth's findings, and the organism was given names such as Eberth's bacillus, Eberthella typhi and Gaffky-Eberth bacillus. Today the bacillus that causes typhoid fever goes by the scientific name of Salmonella enterica enterica
Salmonella enterica enterica
Salmonella enterica enterica is a subspecies of Salmonella enterica, the rod shaped, flagellated, aerobic, Gram-negative bacterium. It is a member of the genus Salmonella. Many of the pathogenic serovars of the S...

, serovar Typhi.

Almroth Edward Wright developed an effective inactivated whole-cell typhoid vaccine that was introduced in 1896. In 1909, Frederick F. Russell
Frederick F. Russell
Brigadier General Frederick Fuller Russell was a U.S. Army physician who developed a typhoid vaccine in 1909. In 1911, the typhoid vaccination program was only the second time an entire U.S. army was immunized. The first was in 1776 when George Washington ordered the vaccination of the...

, a U.S. Army physician, developed an American typhoid vaccine and two years later his vaccination program became the first in which an entire army was immunized. It eliminated typhoid as a significant cause of morbidity and mortality in the U.S. military.

Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. Today, incidence of typhoid fever in developed countries is around 5 cases per 1,000,000 people per year.

An outbreak in the Democratic Republic of Congo in 2004–05 recorded more than 42,000 cases and 214 deaths.

Typhoid fever was also known as suette milliaire in nineteenth-century France.

Famous victims




Famous people who have had the disease include
  • Baiju Bawra
    Baiju Bawra
    Baiju Bawra is an award-winning 1952 Hindi movie directed by Vijay Bhatt. It stars Bharat Bhushan and Meena Kumari.The movie is based on the legend of Baiju Bawra from the days of Mughal Emperor Akbar in India. Baiju is the son of a musician who also grows up to be a musician...

     aka (Baijnath Prasad or Baijnath Mishra), the great Indian singer, musician died of typhoid at the age of 71 on the eve of the Indian festival, Basant Panchami in Vikram Samvat 1670 (1613 CE).
  • Hashimoto Hakaru
    Hashimoto Hakaru
    was a Japanese medical scientist of the Meiji period and Taishō period.He was born on May 5, 1881, in the village of Midau, Nishitsuge, in Mie Prefecture. He graduated from Kyushu University medical school in 1907...

    , discoverer Of Autoimmune Thyroiditis Hashimoto's thyroiditis
    Hashimoto's thyroiditis
    Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease in which the thyroid gland is gradually destroyed by a variety of cell- and antibody-mediated immune processes. It was the first disease to be recognized as an autoimmune disease...

    . Died on January 9, 1934, of typhoid fever.
  • Mary Mallon
    Mary Mallon
    Mary Mallon , also known as Typhoid Mary, was the first person in the United States identified as an asymptomatic carrier of the pathogen associated with typhoid fever. She was presumed to have infected some 53 people, three of whom died, over the course of her career as a cook...

    , more commonly known as Typhoid Mary, survived a childhood episode in Ireland
    Ireland
    Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

     to become an asymptomatic carrier in the United States.
  • Abigail Adams
    Abigail Adams
    Abigail Adams was the wife of John Adams, who was the second President of the United States, and the mother of John Quincy Adams, the sixth...

    , second First Lady of the United States
    First Lady of the United States
    First Lady of the United States is the title of the hostess of the White House. Because this position is traditionally filled by the wife of the president of the United States, the title is most often applied to the wife of a sitting president. The current first lady is Michelle Obama.-Current:The...

    , wife of John Adams
    John Adams
    John Adams was an American lawyer, statesman, diplomat and political theorist. A leading champion of independence in 1776, he was the second President of the United States...

    , died of typhoid fever on October 28, 1818.
  • Prince Albert of Saxe-Coburg-Gotha, British prince consort
    Prince consort
    A prince consort is the husband of a queen regnant who is not himself a king in his own right.Current examples include the Prince Philip, Duke of Edinburgh , and Prince Henrik of Denmark .In recognition of his status, a prince consort may be given a formal...

    , Queen Victoria's husband, died of typhoid Fever on 14 December 1861.
  • Edward VII survived.
  • Joseph Smith
    Joseph Smith
    Joseph Smith was founder of what later became known as the Latter Day Saint movement or Mormons.Joseph Smith may also refer to:-Latter Day Saints:* Joseph Smith, Sr. , father of Joseph Smith...

    , founder of the Church of Jesus Christ of Latter-day Saints Latter Day Saint movement
    Latter Day Saint movement
    The Latter Day Saint movement is a group of independent churches tracing their origin to a Christian primitivist movement founded by Joseph Smith, Jr. in the late 1820s. Collectively, these churches have over 14 million members...

    , contracted typhoid as a child, survived.
  • Henry Frederick, Prince of Wales
    Henry Frederick, Prince of Wales
    Henry Frederick Stuart, Prince of Wales was the elder son of King James I & VI and Anne of Denmark. His name derives from his grandfathers: Henry Stuart, Lord Darnley and Frederick II of Denmark. Prince Henry was widely seen as a bright and promising heir to his father's throne...

  • Princess Victoria of Hesse and by Rhine
    Princess Victoria of Hesse and by Rhine
    Princess Victoria of Hesse and by Rhine, later Victoria Mountbatten, Marchioness of Milford Haven was the eldest daughter of Louis IV, Grand Duke of Hesse and by Rhine and his first wife Princess Alice of the United Kingdom .Her mother died while her brother and sisters...

     survived.
  • Princess Leopoldina of Brazil
    Princess Leopoldina of Brazil
    Princess Leopoldina of Brazil was a member of the Brazilian Imperial Family, the third child and second daughter of Emperor Pedro II of Brazil and his consort Teresa Cristina of the Two Sicilies. By marriage she was Princess of Saxe-Coburg and Gotha, and Duchess in Saxony...

    , Emperor Pedro II of Brazil
    Pedro II of Brazil
    Dom Pedro II , nicknamed "the Magnanimous", was the second and last ruler of the Empire of Brazil, reigning for over 58 years. Born in Rio de Janeiro, he was the seventh child of Emperor Dom Pedro I of Brazil and Empress Dona Maria Leopoldina and thus a member of the Brazilian branch of...

    's daughter, died of typhoid Fever on 7 February 1871.
  • Tadeusz Kosciuszko
    Tadeusz Kosciuszko
    Andrzej Tadeusz Bonawentura Kościuszko was a Polish–Lithuanian and American general and military leader during the Kościuszko Uprising. He is a national hero of Poland, Lithuania, the United States and Belarus...

    , hero of the American Revolution
    American Revolution
    The American Revolution was the political upheaval during the last half of the 18th century in which thirteen colonies in North America joined together to break free from the British Empire, combining to become the United States of America...

     and Polish patriot leader, died of typhoid Fever in Switzerland, 1817.
  • Louisa May Alcott
    Louisa May Alcott
    Louisa May Alcott was an American novelist. She is best known for the novel Little Women and its sequels Little Men and Jo's Boys. Little Women was set in the Alcott family home, Orchard House in Concord, Massachusetts, and published in 1868...

    , author of Little Women
    Little Women
    Little Women is a novel by American author Louisa May Alcott . The book was written and set in the Alcott family home, Orchard House, in Concord, Massachusetts. It was published in two volumes in 1868 and 1869...

    , records contracting it in Hospital Sketches
    Hospital Sketches
    Hospital Sketches is a compilation of four sketches based on letters Louisa May Alcott sent home during the six weeks she spent as a volunteer nurse for the Union Army during the American Civil War in Georgetown.-Summary:...

    .
  • Charles Darwin
    Charles Darwin
    Charles Robert Darwin FRS was an English naturalist. He established that all species of life have descended over time from common ancestry, and proposed the scientific theory that this branching pattern of evolution resulted from a process that he called natural selection.He published his theory...

    , naturalist
    Natural history
    Natural history is the scientific research of plants or animals, leaning more towards observational rather than experimental methods of study, and encompasses more research published in magazines than in academic journals. Grouped among the natural sciences, natural history is the systematic study...

    , during his visit to Chile
    Chile
    Chile ,officially the Republic of Chile , is a country in South America occupying a long, narrow coastal strip between the Andes mountains to the east and the Pacific Ocean to the west. It borders Peru to the north, Bolivia to the northeast, Argentina to the east, and the Drake Passage in the far...

     with HMS Beagle
    HMS Beagle
    HMS Beagle was a Cherokee-class 10-gun brig-sloop of the Royal Navy. She was launched on 11 May 1820 from the Woolwich Dockyard on the River Thames, at a cost of £7,803. In July of that year she took part in a fleet review celebrating the coronation of King George IV of the United Kingdom in which...

    in 1835.
  • Ignacio Zaragoza
    Ignacio Zaragoza
    Ignacio Zaragoza Seguín was a general in the Mexican army, best known for defeating invading French forces at the Battle of Puebla on May 5, 1862 ....

    , Mexican general and Cinco de Mayo
    Cinco de Mayo
    Cinco de Mayo is a holiday held on May 5. It is celebrated nationwide in the United States and regionally in Mexico, primarily in the state of Puebla, where the holiday is called El Dia de la Batalla de Puebla...

     hero. Died of typhoid fever in less than 5 months of his famous victory over the French army in Puebla
    Puebla
    Puebla officially Estado Libre y Soberano de Puebla is one of the 31 states which, with the Federal District, comprise the 32 Federal Entities of Mexico. It is divided in 217 municipalities and its capital city is Puebla....

     on September 8, 1862.
  • Urilla Sutherland Earp
    Wyatt Earp
    Wyatt Berry Stapp Earp was an American gambler, investor, and law enforcement officer who served in several Western frontier towns. He was also at different times a farmer, teamster, bouncer, saloon-keeper, miner and boxing referee. However, he was never a drover or cowboy. He is most well known...

    , first wife of Marshall Wyatt Earp, probably died of Typhoid Fever in or around 1870 in Lamar Township, Missouri.
  • Eugenia Tadolini
    Eugenia Tadolini
    Eugenia Tadolini was an Italian operatic soprano. Admired for the beauty of her voice and stage presence, she was one of Donizetti's favourite singers. During her career she created over 20 leading roles, including the title roles in Donizetti's Linda di Chamounix and Maria di Rohan and Verdi's...

    , a celebrated Italian soprano
    Soprano
    A soprano is a voice type with a vocal range from approximately middle C to "high A" in choral music, or to "soprano C" or higher in operatic music. In four-part chorale style harmony, the soprano takes the highest part, which usually encompasses the melody...

    , died of the disease in Paris in 1872.
  • Leland Stanford Jr. died of typhoid in 1884; his parents founded Stanford University
    Stanford University
    The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...

     in his memory.
  • William Wallace Lincoln
    William Wallace Lincoln
    William Wallace "Willie" Lincoln was the third son of Abraham Lincoln and Mary Todd Lincoln. He died at the age of 11. He was named after Mary's brother-in-law Dr. William Wallace.- Final illness and death :...

    , third son of Abraham Lincoln
    Abraham Lincoln
    Abraham Lincoln was the 16th President of the United States, serving from March 1861 until his assassination in April 1865. He successfully led his country through a great constitutional, military and moral crisis – the American Civil War – preserving the Union, while ending slavery, and...

    , the 16th President of the United States, died February 20, 1862 of typhoid fever.
  • Mary Todd Lincoln
    Mary Todd Lincoln
    Mary Ann Lincoln was the wife of the 16th President of the United States, Abraham Lincoln, and was First Lady of the United States from 1861 to 1865.-Life before the White House:...

    , wife of Abraham Lincoln.
  • Thoby Stephen
    Thoby Stephen
    Julian Thoby Stephen , known as the Goth, was the elder brother of several members of the Bloomsbury Group, namely his sisters Vanessa Bell and Virginia Woolf and his younger brother Adrian....

    , elder brother of novelist Virginia Woolf, died of typhoid fever in 1906 at age 26. The deaths of Woolf's characters, Jacob in Jacob's Room
    Jacob's Room
    Jacob's Room is the third novel by Virginia Woolf, first published on October 26th 1922.The novel centers, in a very ambiguous way, around the life story of the protagonist Jacob Flanders, and is presented entirely by the impressions other characters have of Jacob [except for those times when we do...

    and Percival in The Waves
    The Waves
    - External links :* The Waves, at wikilivres.info...

    , are based on Thoby's.
  • Wilbur Wright, one of the famous Wright Brothers
    Wright brothers
    The Wright brothers, Orville and Wilbur , were two Americans credited with inventing and building the world's first successful airplane and making the first controlled, powered and sustained heavier-than-air human flight, on December 17, 1903...

    . Died May 30, 1912 of typhoid fever.
  • Frank McCourt
    Frank McCourt
    Francis "Frank" McCourt was an Irish-American teacher and Pulitzer Prize–winning writer, best known as the author of Angela’s Ashes, an award-winning, tragicomic memoir of the misery and squalor of his childhood....

    , author of Angela's Ashes
    Angela's Ashes
    Angela's Ashes is a 1996 memoir by the Irish-American author Frank McCourt. The memoir consists of various anecdotes and stories of Frank McCourt's impoverished childhood and early adulthood in Brooklyn, New York and Limerick, Ireland, as well as McCourt's struggles with poverty, his father's...

    . In his memoir, he details nearly dying of the disease in 1940 as a ten-year-old in Limerick
    Limerick
    Limerick is the third largest city in the Republic of Ireland, and the principal city of County Limerick and Ireland's Mid-West Region. It is the fifth most populous city in all of Ireland. When taking the extra-municipal suburbs into account, Limerick is the third largest conurbation in the...

    , Ireland, and his ensuing 4-month-long hospital stay.
  • Stephen Douglas, politician and 1860 presidential runner-up.
  • Dr HJH 'Tup' Scott
    Tup Scott
    Henry James Herbert Scott was a cricketer who played for Victoria and Australia. Scott, a doctor by training, later served as mayor and chief magistrate in the rural New South Wales town of Scone; he died here of typhoid in 1910.His first-class debut was at the age of nineteen in February 1878 for...

    , captain of the 1886 Australian cricket team that toured England, died of typhoid in 1910.
  • Arnold Bennett
    Arnold Bennett
    - Early life :Bennett was born in a modest house in Hanley in the Potteries district of Staffordshire. Hanley is one of a conurbation of six towns which joined together at the beginning of the twentieth century as Stoke-on-Trent. Enoch Bennett, his father, qualified as a solicitor in 1876, and the...

    , English novelist, died in 1931 of typhoid, two months after drinking a glass of water in a Paris Hotel to prove it was safe.
  • Raymond Radiguet
    Raymond Radiguet
    Raymond Radiguet was a French author whose two novels were noted for their explicit themes and writing style and tone.-Early life:...

    , French literary prodigy, died of typhoid at age 20 while on a trip with his mentor, Jean Cocteau.
  • Keshav Baliram Hedgewar
    K. B. Hedgewar
    Keshav Baliram Hedgewar was the founder of the Rashtriya Swayamsevak Sangh . Hedgewar founded the RSS in Nagpur, Maharashtra in 1925, with the intention of promoting the concept of the Hindu nation...

    , founder and first Sarsanghchalak
    Sarsanghchalak
    The Sarsanghchalak is the paramount leader of the Rashtriya Swayamsevak Sangh.He is supposed to be the Philosophical guide of the organisation. He is nominated by the predecessor.The six individuals who have held the post so far have been...

     of Rashtriya Swayamsevak Sangh
    Rashtriya Swayamsevak Sangh
    Rashtriya Swayamsevak Sangh or National Patriotic Organization), also known the Sangh, is a right-wing Hindu nationalist, paramilitary, volunteer, and allegedly militant organization for Hindu males in India...

    , died of typhoid at age 51 on 1940/06/21.
  • Gerard Manley Hopkins
    Gerard Manley Hopkins
    Gerard Manley Hopkins, S.J. was an English poet, Roman Catholic convert, and Jesuit priest, whose posthumous 20th-century fame established him among the leading Victorian poets...

    , Jesuit and poet.
  • Ralph Rose
    Ralph Rose
    Ralph Waldo Rose was an American track and field athlete.He was born in Healdsburg, California....

    , three-time Olympic champion and six-time medalist in throwing events, died of typhoid on October 16, 1913 at age 28.
  • Roger Sherman
    Roger Sherman
    Roger Sherman was an early American lawyer and politician, as well as a founding father. He served as the first mayor of New Haven, Connecticut, and served on the Committee of Five that drafted the Declaration of Independence, and was also a representative and senator in the new republic...

    , a Founding Father of the United States of America.
  • Georgia O'Keeffe
    Georgia O'Keeffe
    Georgia Totto O'Keeffe was an American artist.Born near Sun Prairie, Wisconsin, O'Keeffe first came to the attention of the New York art community in 1916, several decades before women had gained access to art training in America’s colleges and universities, and before any of its women artists...

    , a famous painter, survived
  • Ravi Shankar
    Ravi Shankar
    Ravi Shankar , often referred to by the title Pandit, is an Indian musician and composer who plays the plucked string instrument sitar. He has been described as the best known contemporary Indian musician by Hans Neuhoff in Musik in Geschichte und Gegenwart.Shankar was born in Varanasi and spent...

    , musician, survived
  • Tsar Nicholas II of Russia
    Nicholas II of Russia
    Nicholas II was the last Emperor of Russia, Grand Prince of Finland, and titular King of Poland. His official short title was Nicholas II, Emperor and Autocrat of All the Russias and he is known as Saint Nicholas the Passion-Bearer by the Russian Orthodox Church.Nicholas II ruled from 1894 until...

     had typhoid in 1900, survived.
  • Helen Thomas, the young regent of Timbuktu from 1910 was stricken with Typhoid and succumbed to the illness at the age of 34.
  • Heath Bell
    Heath Bell
    Heath Justin Bell is an American professional baseball pitcher, who is currently a free agent. After taking over the San Diego Padres closer role from Trevor Hoffman in 2009, Bell was named a three-time All-Star and has been awarded with the Rolaids Relief Man Award twice and has also won the DHL...

    , Relief Pitcher
    Relief pitcher
    A relief pitcher or reliever is a baseball or softball pitcher who enters the game after the starting pitcher is removed due to injury, ineffectiveness, fatigue, ejection, or for other strategic reasons, such as being substituted by a pinch hitter...

     San Diego Padres
    San Diego Padres
    The San Diego Padres are a Major League Baseball team based in San Diego, California. They play in the National League Western Division. Founded in 1969, the Padres have won the National League Pennant twice, in 1984 and 1998, losing in the World Series both times...

     acquired on 2010 trip to Fiji
    Fiji
    Fiji , officially the Republic of Fiji , is an island nation in Melanesia in the South Pacific Ocean about northeast of New Zealand's North Island...

    , survived.

In fiction

  • Gilbert Blythe
    Gilbert Blythe
    Gilbert Blythe is a fictional character in Lucy Maud Montgomery's Anne of Green Gables series of novels.In the CBC Television film adaptations of the 1980s, Gilbert Blythe is portrayed by Jonathan Crombie. For the 1934 film adaption, Gilbert is portrayed by Tom Brown. In the Japanese anime...

     (of the Anne of Green Gables series) almost dies of typhoid fever in Anne of the Island
    Anne of the Island
    Anne of the Island is a the third book in the Anne of Green Gables series, written by Lucy Maud Montgomery about Anne Shirley.Anne of the Island was published in 1915, seven years after the bestselling Anne of Green Gables...

    by L.M. Montgomery.
  • Walter Blythe (son of Anne and Gilbert Blythe in the latter Anne of Green Gables books) was in recovery from typhoid in "Rilla of Ingleside" and this is seen as the reason why he does not enlist at the onset of WWI.
  • Johann "Hanno" Buddenbrook, in Thomas Mann
    Thomas Mann
    Thomas Mann was a German novelist, short story writer, social critic, philanthropist, essayist, and 1929 Nobel Prize laureate, known for his series of highly symbolic and ironic epic novels and novellas, noted for their insight into the psychology of the artist and the intellectual...

    's novel, Buddenbrooks
    Buddenbrooks
    Buddenbrooks was Thomas Mann's first novel, published in 1901 when he was twenty-six years old. The publication of the 2nd edition in 1903 confirmed that Buddenbrooks was a major literary success in Germany....

    , dies of typhoid fever, and the book includes a long medical description of the disease and its effects.
  • John H. Watson (Sherlock Holmes
    Sherlock Holmes
    Sherlock Holmes is a fictional detective created by Scottish author and physician Sir Arthur Conan Doyle. The fantastic London-based "consulting detective", Holmes is famous for his astute logical reasoning, his ability to take almost any disguise, and his use of forensic science skills to solve...

    ' famed companion) nearly died of typhoid contracted in India, and returned to England for convalescence – where he first met the detective.
  • Scarlett O'Hara's mother Ellen in Gone With the Wind
    Gone with the Wind
    The slaves depicted in Gone with the Wind are primarily loyal house servants, such as Mammy, Pork and Uncle Peter, and these slaves stay on with their masters even after the Emancipation Proclamation of 1863 sets them free...

    . Scarlett's sisters Suellen and Carreen also contract the disease, but survive.
  • Suttree
    Suttree
    Suttree is a semi-autobiographical novel by Cormac McCarthy, published in 1979. Set in 1951 in Knoxville, Tennessee, the novel follows Cornelius Suttree, who has repudiated his former life of privilege to become a fisherman on the Tennessee River. The novel has a fragmented structure with many...

     in the Cormac McCarthy novel of the same name nearly dies of typhoid fever in the final scenes of the novel.
  • In the 1950 western Stars in My Crown, the town is devastated by typhoid spread by a school's well.
  • Port Moresby in Paul Bowles' The Sheltering Sky, in North Africa
  • Jane Eyre and her husband, Jane's parents, in Jane Eyre
    Jane Eyre
    Jane Eyre is a novel by English writer Charlotte Brontë. It was published in London, England, in 1847 by Smith, Elder & Co. with the title Jane Eyre. An Autobiography under the pen name "Currer Bell." The first American edition was released the following year by Harper & Brothers of New York...

    by Charlotte Brontë; Jane's close school friend, Helen Burns, dies of typhoid as well.
  • Tom's friend Arthur suffers from a near fatal bout with typhoid but ultimately recovers in Thomas Hughes' novel Tom Brown's Schooldays
    Tom Brown's Schooldays
    Tom Brown's Schooldays is a novel by Thomas Hughes. The story is set at Rugby School, a public school for boys, in the 1830s; Hughes attended Rugby School from 1834 to 1842...

    .
  • Joey, one of the few remaining human survivors who can read, dies of typhoid fever in George Stewart's Earth Abides
    Earth Abides
    Earth Abides is a 1949 post-apocalyptic science fiction novel by American writer George R. Stewart. It tells the story of the fall of civilization from deadly disease and its rebirth. Beginning in the United States in the 1940s, it deals with Isherwood "Ish" Williams, Emma, and the community they...

    .
  • Yevgeny Vassilievitch Bazarov, the nihilist in Ivan Turgenev's Fathers and Sons
    Fathers and Sons
    Fathers and Sons is an 1862 novel by Ivan Turgenev, his best known work. The title of this work in Russian is Отцы и дети , which literally means "Fathers and Children"; the work is often translated to Fathers and Sons in English for reasons of euphony.- Historical context and notes :The fathers...

    ,
    dies of typhoid fever contracted through a cut in his finger near an infected corpse.

External links