Salmonella Typhi Infected Food Employee Potentially Exposes Restaurant Patrons

This past week, a San Francisco foodservice worker diagnosed with Salmonella Typhi, had potentially exposed restaurant patrons to infection (news report below). Salmonella Typhi is the causative agent of typhoid fever (CDC Report below).

As required by the US Food Code, (http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm181242.htm#part2-2), employees must contact their manager before coming to work when they have the symptoms of diarrhea, vomiting or jaundice, or have been diagnosed with, or have been exposed to, one of following reportable agents:
    a) Norovirus,
    b) Hepatitis A virus,
    c) Shigella spp.,
    d) Enterohemorrhagic or Shiga toxin-producing Escherichia coli, or
     e) Salmonella Typhi

 A question that often arises is why Salmonella Typhi is singled out from the other strains of Salmonella for reporting, especially since other strains of Salmonella are more likely to be involved in foodborne illness cases.

Salmonella Typhi, the causative agent for typhoid fever, is a strain that is only carried by humans and is spread through direct contact or through food handled by an infected person. Basically, the organism passes through the intestinal tract and then invades the bloodstream leading to multisystem infection. If not treated, it invades the liver, spleen, bone marrow, gall bladder and lymph nodes.  

The symptoms are related to the systematic infection that results. The primary symptoms of Typhoid fever are typified by high sustained fever of 103 to 104 degree F, which is related to the intensive infection. Symptoms also include stomach pains, headache, and a rash or rose color spots. Untreated, the disease can progress to delirium, intestinal hemorrhaging, and potentially death (approximately 20% mortality rate). 

In some cases, people can become carriers and will shed the organism. This was the case of Typhoid Mary, a Salmonella typhi- infected house cook who contaminated approximately 50 of the people served with illness (in the years from 1900 to about 1915).  

Salmonella Typhi infection is seldom seen in the United States, in fact, most infections occur when people travel overseas. However, health officials must pay special attention in order to prevent large scale outbreaks.