Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water. Patients 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. About 3%-5% of patients become carriers of the bacteria after the acute illness. Some patients suffer a very mild illness that goes unrecognized. These patients can become long-term carriers of the bacteria. The bacteria multiplies in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage. These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever for many years.
How does the bacteria cause disease, and how is it 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. The bacteria then multiply in the cells of these
organs and
reenter the bloodstream. Patients develop symptoms, including
fever,
when the organism reenters the bloodstream. 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 for diagnosis in cultures from the stool
tested in
the laboratory. Stool cultures are sensitive in the early and late stages of the disease but often
must be supplemented with blood cultures to make the definite diagnosis.
What are the symptoms of typhoid fever?
The incubation period is usually one to two weeks, and the duration of
the
illness is about four to six weeks. The patient experiences
People with typhoid fever usually have a sustained fever as high as 103 F-104
F (39 C-40 C).
Chest
congestion develops in many patients, 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
patients have
recurrent symptoms (relapse) after feeling better for one to
two weeks.
Relapses are actually more common in individuals treated with
antibiotics.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Salmonella bacteria are known to cause salmonellosis, typhoid fever, and paratyphoid fever in humans. Salmonella infection is usually caused by ingesting large amounts of the bacteria in contaminated food or water.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
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