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Though it is dangerous, and preventable through sanitation and cleanliness, Typhoid Fever is not a serious or not threatening condition to all people infected by it. Approximately 3-5% of those infected with this illness become carriers of the disease who chronically carry it in their body, cultivating, and producing millions of the bacterium in their feces. The most well-known and widely criminalized carrier of Typhoid bacterium was "Typhoid Mary", an Irish immigrant brought into captivity twice by the authorities, dying at age 69 from pneumonia after 27 years on Rhode Island.

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Typhoid Fever is a lethal disease caused by Salmonella Typhi bacterium that devastated and constantly plagued various cities & states  throughout several generations since the early 1800s, still persisting to this day, where it still thrives in developing countries and those that have overused antibiotics to the state of resistance.

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Typhoid is endemic to Pakistan, where poor infrastructure, low vaccination rates and overpopulated city dwellings persist. Doctors in the Sindh province were not surprised by an outbreak in November 2016 - until cases proved unresponsive to ceftriaxone, used to treat multidrug-resistant, or MDR, strains of typhoid.

Only four isolated cases of extensively drug-resistant, or XDR, typhoid had previously been reported worldwide, according to Dr. Elizabeth Klemm, an infectious disease geneticist at the Wellcome Sanger Institute in England.

The outbreak's origins were clear: Early case mapping revealed large clusters of victims around sewage lines in the city of Hyderabad. Dr. Hasan's colleagues visited the region and found water sources that could be contaminated by leaking sewage pipes.

Four deaths have been reported so far, according to the National Institute of Health Islamabad. At least one travel-related case has been detected in the United Kingdom.

Genetic sequencing revealed that a common, aggressive MDR typhoid strain called H58 interacted with another bacteria, likely E. coli, and acquired from it an additional DNA molecule, called a plasmid, that coded for resistance to ceftriaxone.

The findings were disturbingly simple: XDR strains can materialize in one single step, virtually anywhere where the H58 strain and the added plasmid are both present - whether a sewer system or even a single human gut.

"There are multiple worst-case scenarios," said Dr. Klemm. "One is that this strain spreads to other regions through migration. But the other is that it pops up elsewhere on its own - plasmids with drug resistance are everywhere."

But the accumulation of resistance genes in the Sindh strain was hardly an ambush, according to a commentary by vaccine experts at the University of Maryland School of Medicine.

The 1948 discovery of antibiotic treatment for typhoid plunged the infection's fatality rate from almost one in four to just one in 100, triggering "an epic thrust-and-parry duel" between powerful drugs and "a wily bacterial foe's stepwise acquisition of resistance to them," wrote Dr. Myron M. Levine and Dr. Raphael Simon.

Doctors still prescribe an estimated 50 million doses of antibiotics for typhoid globally each year. In Karachi, the capital of Sindh province, antibiotic resistance is increasing by 30 percent each year, according to the W.H.O.; at that rate, all typhoid cases in the city will be resistant to multiple drugs by 2020.

Physicians are treating the Sindh strain with azithromycin and other more expensive treatments that must be administered in hospital settings.

"Once we aren't able to treat this effectively, we're going back to the pre-antibiotic era. That would mean a lot of fatalities in our future," Dr. Klemm said.

To preserve the last line of defense, public health officials have launched a campaign to vaccinate 250,000 children in Hyderabad using a new typhoid conjugate vaccine, Typbar-TCV, recently prequalified by the W.H.O. The vaccine lasts at least five years and can be given to children as young as six months old, according to the W.H.O.

Experts are also reinforcing hygiene habits for prevention: washing hands frequently, boiling drinking water and eating well-cooked foods. In the longer term, modern sanitation infrastructure is needed.

The vaccination campaign has faced local opposition, according to local news reports, amid rumors that the vaccines have been poisoned in a Western effort to harm children. Similar suspicions have persisted since 2011, when a posed hepatitis B campaign helped gather intelligence before the Abbottabad raid that killed Osama bin Laden. Two polio vaccination workers were killed in Pakistan this January.

GAVI, The Vaccine Alliance, a public-private global health partnership working to increase access to immunization, has pledged $85 million to ensure that typhoid vaccines reach developing countries.

"It's a global concern at this point," said Dr. Eric Mintz, an epidemiologist at the Centers for Disease Control and Prevention. "Everything suggests this strain will survive well and spread easily - and acquiring resistance to azithromycin is only a matter of time."

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'We're Out of Options': Doctors Battle Drug-Resistant Typhoid Outbreak

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Typhoid is endemic to Pakistan, where poor infrastructure, low vaccination rates and overpopulated city dwellings persist. Doctors in the Sindh province were not surprised by an outbreak in November 2016 - until cases proved unresponsive to ceftriaxone, used to treat multidrug-resistant, or MDR, strains of typhoid.

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In recent years since 2004, Typhoid Fever is shown to have developed resistances against several antibiotics commonly used for it, such as the well recognized Chloramphenicol drug. This further emphasizes that one should not use antibiotics excessively, as they are made to be a last line defense, not quick fixes to annoying colds.

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The emergence of antibiotic resistance in typhoid fever

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Typhoid fever, caused by Salmonella typhi, causes over 20 million cases annually, with at least 700,000 deaths. The main burden of disease is in devel...

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Typhoid fever is an illness that has proved fatal for thousands, originating from the strain of Salmonella Typhi, and entering one's system through the transfer of human excrement and contaminated liquids. Humans carry this bacterium in their bloodstream and intestinal tract, where it leaves the body through feces. Once this bacterium enters the bloodstream, it is accompanied by fever and other common signs of illness that lead it be occasionally confused with other infections. The typhoid bacterium can eat away at the intestinal tract to the point where perforations can occur, leading to chronic pain and agonizing death if not treated in haste.

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Cases of Typhoid Fever severely plummeted  when filtration systems through chlorination were installed into various cities that were known for their lack of sanitation. Vaccinations were also introduced into the military during World War 1, where solders lined up fro shots that gave them resistances to the illness. This vaccination was later improved in London, and became a stepping stone for later antibiotics that allowed America to suppress and drastically to reduce the number of fatalities from this disease.

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It is the only effective vaccine that is also safe for infants, and already it is made cheaply and used widely in India. The Oxford Vaccine Group, which ran the trial, and the Bill & Melinda Gates Foundation, which paid for it, hope the World Health Organization will endorse the vaccine soon.

"These are great results," said Dr. Anita Zaidi, the foundation's director of diarrheal diseases. "And challenge tests are a great way to short-circuit the process of proving it works.

"If we'd done this in the field, we would have had to follow children for three or four years."

So-called challenge tests involve giving subjects an experimental vaccine and then deliberately infecting them with the disease to see if it protects them.

These tests can only be done with illnesses - like cholera or malaria - that can be rapidly and completely cured, or with diseases - like seasonal flu - that normally do not damage healthy adults.

Still, there was a good chance that the participants in Oxford would be unpleasantly sick with typhoid fever for several days until their antibiotics kicked in.

So what would motivate dozens of well-educated Britons to swallow a vial full of the germs that made Typhoid Mary famous? In interviews, they gave various reasons.

Some, like Mr. Duggan, were curious. Some wanted to help poor people. And some mostly wanted the cash.

Participants who followed all the steps, which included recording their temperatures online, making daily clinic visits and providing regular blood and stool samples, received about $4,000.

They all said they understood the risks.

Typhoid got its fearsome reputation in the pre-antibiotic age, but these days it normally can be driven out of the body with common antibiotics, like ciprofloxacin or azithromycin.

All participants had to be healthy adults, ages 18 to 60, with ultrasound scans proving their gallbladders were stone-free.

(The bacteria can persist for decades by clinging to gallstones - which is probably how Typhoid Mary, working as a cook in grand houses and a maternity hospital, infected so many people between 1900 and 1915 without ever feeling ill herself.)

Different participants had very different experiences.

Mr. Duggan was sick for three days with flulike symptoms: "proper flu, where you don't want to get out of bed," he said. His temperature rose to 102 degrees, and he had joint pains and a bad headache.

Once a blood culture proved he had typhoid, he got antibiotics right away; he was not released from treatment until three typhoid-free blood and stool samples proved he was out of danger.

He later was told that he had been in the trial's placebo arm and had received a meningitis vaccine instead. (Modern ethics boards frown on useless "sugar pill" placebos.)

Nick J. Crang, 24, a graduate student in proteomics, also got the placebo. But somehow he never got sick, even after two typhoid challenges a year apart.

"It turns out I've got innate immunity to typhoid," he said.

So does he feel superhuman? "No, I'm the lab rat who's screwing with the figures."

He did give extra blood samples to researchers curious about his immune system.

The bacterial doses were offered by nurses wearing plastic aprons, gloves and face shields to prevent splashing. Participants also donned aprons and goggles, and were asked to first drink bicarbonate of soda to neutralize their stomach acid.

But there were no steaming beakers out of Vincent Price movies. "It was all quite underwhelming," said Daina Sadurska, 26, a grad student in biology. "It was served in a typical laboratory tube. I expected it to taste more 'typhoidy.' Not like poop, that is - the things that make poop smell like poop are absolutely different bacterially."

"But I expected something. A lot of cultures have a typical smell. It was clear, I think, and it tasted like nothing particular."

Ms. Sadurska never fell ill and later learned that she had gotten the vaccine. She had a unique reason for joining: her great-great-grandmother and one of her aunts died during a typhoid epidemic in Latvia during World War I.

"When I told my mother I was doing this, she reminded me of that episode," she said. "When I signed up, I thought, 'Why on Earth am I doing this?' But I'm a biologist. All sorts of boogeymen become a lot less scary when you know more about them."

The $4,000 was also "a welcome addition," she said. Oxford students get only $17,600 a year to live in a city with costs almost as high as London's.

She and Mr. Crang, her boyfriend, used the money to visit Croatia, Israel and her family in Latvia. They have both signed up for a second vaccine trial that will pay for his laser eye surgery and then a trip together to Australia.

Faye Francis, a 42-year-old psychiatric nurse, said she felt "happy to be doing something that could help millions of poor people who haven't got antibiotics."

"But I won't lie," she added. "The money was a big part of it."

She used it to take her husband and three children on a vacation in Cornwall "and buy a few bits for the car and the house."

Her mother was not happy. "She said, 'That's ridiculous - don't think about the money, think about your health!' " Mrs. Francis said. "And people were telling me horror stories about things they'd seen on TV. So I didn't go on about it to my parents after that."

She got sick and "felt rotten for about a week" with a 101-degree fever, headache and nausea.

"But I still went to work," she said. "I felt a bit guilty about not going when I had an illness I'd given myself."

Because her job is to distribute medicine on home visits, no patients were endangered, she said. (Mr. Duggan, the medical student, was also quick to say that he took part during a period when he was not assigned to hospital rounds.)

"They don't let you do it if you've got preschoolers or children in nappies," Mrs. Francis said. "And you're not allowed to handle food, so my husband did all the cooking."

During the worst week, "you feel sorry for yourself and you say 'I'm never doing that again,' " she said. "And then it's like childbirth - you get amnesia, and you do it again. I've just signed up for a second trial."

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They Swallowed Live Typhoid Bacteria - On Purpose

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It is the only effective vaccine that is also safe for infants, and already it is made cheaply and used widely in India. The Oxford Vaccine Group, which ran the trial, and the Bill & Melinda Gates Foundation, which paid for it, hope the World Health Organization will endorse the vaccine soon.

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Abstract

Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. We hereby present a case report of 35-year-old male with multiple (24) intestinal perforation in the Ileum and Cecum.

Keywords: Asia, Multiple ileal perforations, Salmonellosis

Introduction

Intestinal perforation is a common cause of peritonitis necessitating emergency surgical intervention. Perforation of the bowel from typhoid perforation is a serious abdominal complication. The prevalence of typhoid fever is gradually decreasing worldwide; however, it still remains endemic in the Indian subcontinent.[ 1] Although, intestinal hemorrhage is the most common complication of typhoid fever yet intestinal perforation continues to be the most frequent cause of its high morbidity and mortality.[ 2] In general, hemorrhage and perforation occur in the terminal ileum secondary to necrosis of Peyer's patches at 2-3 weeks after the onset of the disease. Mortality rates of typhoid intestinal perforation (TIP) cases are reported to be between 5% to 62%.[ 3, 4] Perforation of terminal ileum is a cause for acute obscure peritonitis, heralded by exacerbation of abdominal pain associated with tenderness, rigidity and guarding, most pronounced over right iliac fossa. However, for many patients in a severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention.[ 5] While early surgical procedures are regarded as definitive treatments along with pre-operative resuscitation and post-operative intensive care, the methods that should be used in surgery are still contentious. In the present case report, we present a rare case of 24 perforations in the terminal ileum and cecum of a patient. To the best of our knowledge, this is the 3 rd highest number of intestinal perforations from typhoid in an adult patients reported in the literature.[ 6, 7]

Case Report

A 35-year-old male patient was admitted in surgery out-patient department with complains of fever for 2 weeks, abdominal pain and vomiting for 4 days, abdominal distension for 2 days, and constipation for 2 days. He did not receive any treatment during 2 weeks. There was no history of chronic abdominal pain or analgesic abuse, but patient was a smoker and alcoholic. There was no any history suggestive of previous typhoid infection. On physical examination, abdomen was tense, tender, and distended with absent bowel sound. Both guarding and rigidity were present all over the abdomen. On digital rectal examination, there was empty rectum. An upright abdominal radiograph showed free gas under both domes of diaphragm. Laboratory examinations gave the following results: Hematocrit 30%, white blood cell count 14500/cm ³, platelets 268 000/cm ³, sodium 138 mEq/L, potassium 3.2 mEq/L, blood urea 32 mg/dl, S. Creatinine 1.6 mg/dl, blood glucose 110 mg/dl, and total bilirubin of 2.5 mg/dl. Diagnostic test for hepatitis B, hepatitis C and HIV were negative. The patient was Widal positive (Titer of > 1:160). An abdominal ultrasound showed features consistent with intestinal perforation showing both free fluid and free air with fine floating echoes in peritoneal cavity. However, blood culture was negative for Salmonella typhi in the patient. No bile culture was performed pre-operatively. Hence, the diagnosis of acute peritonitis due to intestinal perforation was made pre-operatively.

The patient was resuscitated with intravenous fluid and commenced on antibiotics ceftriaxone and metronidazole pre-operatively. Nasogastric tube insertion for decompression and urethral catheterization was carried out for monitoring urine output. Exploratory laparotomy was performed through midline incision and fecal peritonitis with exudative flakes all over the intestine was found. Thorough peritoneal lavage was carried out with normal saline. There were 24 perforations (21 in terminal ileum and 3 in cecum) present in distal 35-40 cm of terminal ileum reaching up to ileocecal junction and the Cecum on anti-mesenteric border as shown in Figures and . Resection of the perforated intestinal segment with ileo-transverse anastomosis (side-to-side) with proximal loop ileostomy was performed. Abdominal tube drain Fr. 30 was put in pelvis after thorough peritoneal lavage using the normal saline and abdomen was closed in layers. Patient was kept on i.v. fluids and nil orally for 3 days. Broad spectrum antibiotic in the form of 3 rd generation cephalosporin with metronidazole and fluoroquinolone were given for 7 days. Nasogastric tube and abdominal drain tube were removed on 3 rd post -operative day (POD). Ileostomy started functioning on 4 th POD. Patient was discharged on 7 th POD with oral fluoroquinolone for 7 days. Histopathological examination revealed evidence of severe acute inflammation, with fibrinopurulent exudates extending along the serosal surface of intestine and acute and chronic inflammation was observed immediately adjacent to the site of perforation. Evidence of villous blunting and elongation of the crypts was observed, which suggests chronic mucosal injury. We were unable to isolate S. typhi from resected bowel specimen; however, stool culture was positive for S. typhi. We were unable to perform Polymerase chain reaction for isolation of S. typhi and other serotypes responsible for TIP due to scarcity of resources at our center. These findings are consistent with TIP. On the basis of these findings, the diagnosis of typhoid enteric perforation was confirmed. Patient came regularly for follow-up, gained weight, and managed ileostomy properly. We closed ileostomy after 12 weeks.

Discussion

Typhoid ileal perforation still remains a very severe condition in tropical countries.[ 1] Its incidence ranges from 0.9% to 39%, with a mortality rate, which remains very high.[ 2, 3] Primarily, the mortality and the morbidity rate do not depend on the surgical technique, but rather on the general status of the patient, the virulence of the salmonella and the duration of disease evolution before surgical treatment. That is why, it is so important to provide adequate pre-operative management associating aggressive resuscitation with antibiotic therapy. In the literature, it is usually advocated that the last 60 cm of the ileum presents a high concentration of Peyer's patches whose infection is a source of intestinal perforation.[ 5]

Typhoid fever with perforation is best managed by early surgical intervention. Various surgical options available are simple primary closure, primary closure with omental patch, resection and anastomosis, and closure with ileo-transverse colostomy. Fecal fistula, which is the most common complication of enteric perforation, may occur either because of anastomotic dehiscence, reperforation or different site of perforation. Simple primary closure is still the procedure of choice as it is quick and cost-effective.[ 8] However, some of the studies showed that the development of fecal fistula and mortality is unrelated to the operative procedure.[ 9]

In our case report, patient was a middle aged Indian male; enteric perforation is more common in middle aged male because they are more exposed to infection as they consume food outside, which may be unhygienic.[ 10] Traditionally, diagnosis is made mainly on the basis of clinical history and examination, X-ray abdomen, and ultrasound abdomen supported our diagnosis. Although serologic and bacteriologic data may be supportive, these are frequently negative. Blood cultures are positive for S. typhi in only 3-34% of cases of typhoid perforation, and cultures of the stool and peritoneal fluid are usually negative for this organism.[ 11] Salmonella paratyphi B involves colon more frequently than terminal ileum.[ 12] Unfortunately, we cannot phase type strain at our center. On exploration, we found gross peritoneal contamination with relatively healthy proximal intestine. There were 24 perforations present in the distal 35-40 cm of ileum including cecum. So, we decided to perform resection of perforated gut along with cecum and ascending colon and ileotransverse side-to-side anastomosis with proximal defunctioning ileostomy. Histopathological examination revealed acute and chronic inflammation at and near to perforated intestine with cryptic changes with peyer's patches inflammation. These findings are consistent with TIP. Pathophysiology of TIP is complex depending upon both host immunity and bacterial virulence. Musharraf et al. recommended performing resection and anastomosis in multiple perforations with relatively healthy gut as was carried out in this patient.[ 13] Early and appropriate surgical intervention with effective pre -and post-operative care may improve survival in TIP.[ 3]

Conclusion

Despite global scientific development typhoid fever and its complications continue to be a great health problem especially in developing country. The management of salmonella enteric perforation needs appropriate early surgical intervention, effective resuscitation in the pre-operative period, post-operative care, and use of proper antibiotics. In our study, there is no evidence of decreased immunity of patient, so increased virulence of bacteria might be probable cause of such complication of typhoid enteritis. The key to improved survival in this deadly disease lies not in a better operation or improved perioperative care, but in the prevention of typhoid fever by providing safe drinking water and improved sanitation methods for all of the global community.

Footnotes

Source of Support: Nil.

Conflict of Interest: None declared.

References

1. Procop GW, Cockerill FL. Enteritis caused by E. coli and Shigella species. In: Wilson WR, Sande MA, editors. Current Diagnosis and Treatment in Infectious Disease. New York: McGraw Hill; 2001. pp. 559-66.

8. Beniwal US, Jindal D, Sharma J, Jain S, Shyam G. Comparative study of operative procedures in typhoid perforation. Indian J Surg. 2003;65:172-7.

10. Patil PV, Kamat MM, Milan M. Hindalekar. Spectrum of perforative peritonitis-A prospective study of 150 cases. Bombay Hosp J. 2012;54:38-50.

12. Elisha SO. Pathology and pathogenesis of typhoid fever.

13. Husain M, Khan RN, Rehmani B, Haris H. Omental patch technique for the ileal perforation secondary to typhoid fever. Saudi J Gastroenterol. 2011;17:208-11. [ PMC free article]

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Typhoid Intestinal Perforation: 24 Perforations in One Patient

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Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed.

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What is typhoid fever?

Typhoid fever is an acute illness associated with fever caused by the Salmonella enterica serotype Typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

The incidence of typhoid fever in the United States has markedly decreased since the early 1900s, when tens of thousands of cases were reported in the U.S. Today, less than 400 cases are reported annually in the United States, mostly in people who have recently traveled to Mexico and South America. This improvement is the result of better environmental sanitation. India, Pakistan, and Egypt are also known as high-risk areas for developing this disease. Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease.

How Do People Get Typhoid Fever?

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

About 3%-5% of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized. These people may become long-term carriers of the bacteria -- even though they have no symptoms -- and be the source of new outbreaks of typhoid fever for many years.

How Is Typhoid Fever Diagnosed?

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples. If a test result isn't clear, blood or urine samples will be taken to make a diagnosis.

Continued

What Are the Symptoms of Typhoid Fever?

The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks. Symptoms include:

Poor appetite

Generalized aches and pains

Fever as high as 104 degrees Farenheit

Lethargy

Chest congestion develops in many people, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10% of people have recurrent symptoms after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotics.

How Is Typhoid Fever Treated?

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.

Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of rare serious side effects, chloramphenicol has been replaced by other effective antibiotics. The choice of antibiotics is guided by identifying the geographic region where the infection was contracted (certain strains from South America show a significant resistance to some antibiotics.) If relapses occur, patients are retreated with antibiotics.

Those who become chronically ill (about 3%-5% of those infected), can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will provide a cure.

For those traveling to high-risk areas, vaccines are now available.

Typhoid Fever At A Glance

Typhoid fever is caused by Salmonella enterica serotype Typhi bacteria.

Typhoid fever is contracted by the ingestion of contaminated food or water.

Diagnosis of typhoid fever is made when Salmonella bacteria are detected with stool, urine, or blood cultures.

Typhoid fever is treated with antibiotics.

Typhoid fever symptoms are poor appetite, headaches, generalized aches and pains, fever, and lethargy.

Approximately 3%-5% of patients become carriers of the bacteria after the acute illness.

Sources

SOURCE: Centers for Disease Control.

Typhoid Fever from MedicineNet.

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Typhoid Fever Causes, Symptoms, Treatment and Vaccine

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Typhoid fever is an acute illness associated with fever caused by the Salmonella enterica serotype Typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.