WEBVTT - Ep 61 Typhoid: There's Something About Mary 0:00:01.200 --> 0:00:05.160 Number one, The camp at Chickamauga was a perfect hell 0:00:05.320 --> 0:00:09.680 on earth. War itself would have been a paradise compared 0:00:09.720 --> 0:00:12.920 with the peace of this camp. I saw many awful 0:00:12.920 --> 0:00:15.760 sites there, men dying under the trees for the want 0:00:15.800 --> 0:00:18.240 of a glass of water. I found there men who 0:00:18.280 --> 0:00:21.040 had been sick with typhoid fever for days, and who 0:00:21.079 --> 0:00:24.720 had not received medical attendants. No one had even taken 0:00:24.800 --> 0:00:28.840 their temperature. It was awful for five hundred men in 0:00:28.920 --> 0:00:32.159 hospitals there were only a dozen attendants. The water from 0:00:32.200 --> 0:00:34.960 the creek was simply mud, and yet the boys had 0:00:35.000 --> 0:00:37.960 to bathe in it and drink it. Everything about the 0:00:37.960 --> 0:00:41.040 camp was badly managed. As for the food, there is 0:00:41.080 --> 0:00:43.240 only one way to describe it. 0:00:43.240 --> 0:00:45.640 It was rotten. Number two. 0:00:46.440 --> 0:00:49.000 Someone is to blame for keeping an army of forty 0:00:49.000 --> 0:00:51.200 five thousand men at a camp where all the water 0:00:51.320 --> 0:00:53.400 was unfit for a dog to drink, where there was 0:00:53.440 --> 0:00:56.200 no drainage, no proper food or medicine, and where the 0:00:56.200 --> 0:00:59.720 conditions were so unhealthy that every man of forty five 0:00:59.720 --> 0:01:03.960 thousand and had intestinal troubles. Three fourths of the army 0:01:04.040 --> 0:01:06.560 slept in little dog tents, as we called them. They 0:01:06.600 --> 0:01:09.520 were five feet long and four feet high. There were 0:01:09.560 --> 0:01:12.039 no cots. The men slept on the ground, and it 0:01:12.120 --> 0:01:15.680 rained nearly all the time for six weeks. Our division 0:01:15.680 --> 0:01:18.600 hospital was arranged to hold two hundred men, but we 0:01:18.640 --> 0:01:21.640 had over five hundred sick men in it. Each tent 0:01:21.760 --> 0:01:24.160 was arranged to hold six men, but we had ten 0:01:24.280 --> 0:01:27.760 and twelve crowded in. There were not cots enough, and 0:01:27.880 --> 0:01:30.520 sick men had to lie on litters on the wet ground, 0:01:30.680 --> 0:01:34.160 sometimes for a week. The sick came in fifty and 0:01:34.240 --> 0:01:36.800 seventy five at a time, and there were no cots, 0:01:36.840 --> 0:01:39.800 no medicines, no food for them except the irregular army 0:01:39.880 --> 0:01:43.440 rations issued to well men. The men detailed for nurses 0:01:43.480 --> 0:01:46.160 were the poorest soldiers in the camp. They nursed the 0:01:46.240 --> 0:01:48.640 sick eight hours in the day and then worked three 0:01:48.640 --> 0:01:51.800 hours digging sinks and trenches and cleaning up the camps. 0:01:53.440 --> 0:01:57.480 Number three, in the camp of the third United States 0:01:57.520 --> 0:02:00.760 Volunteer Cavalry, we found the sinks fold to the top 0:02:00.880 --> 0:02:04.560 with fecal matter. Soiled paper was scattered around the sinks, 0:02:04.880 --> 0:02:07.680 and the woods behind the regimental camp was strewn with 0:02:07.720 --> 0:02:11.680 fecal matter. The second Kentucky Volunteer Infantry was located in 0:02:11.720 --> 0:02:15.440 the woods. Fecal matter was deposited around trees, and flies 0:02:15.520 --> 0:02:18.200 swarmed over these deposits, not more than one hundred and 0:02:18.280 --> 0:02:21.560 fifty feet from the company mess tents. The odor in 0:02:21.639 --> 0:03:14.839 the woods just outside of the regimental lines was vile. Yeah, yeah, 0:03:14.880 --> 0:03:18.200 why why are they poop and InSync? 0:03:18.360 --> 0:03:21.240 Like there was nowhere else to poop? Okay, dig a 0:03:21.320 --> 0:03:22.760 hole what I mean? 0:03:22.800 --> 0:03:26.280 So, but all the holes got filled either with poop 0:03:26.520 --> 0:03:30.520 or with water, and then the rain water would make 0:03:30.600 --> 0:03:33.040 the pop rise to the surface and spread around. 0:03:33.440 --> 0:03:36.040 That's atrocious. Yeah. 0:03:36.360 --> 0:03:41.119 So that was from the report of the Commission appointed 0:03:41.120 --> 0:03:43.640 by the President to investigate the conduct of the War 0:03:43.680 --> 0:03:47.000 Department in the War with Spain, essentially the Spanish American 0:03:47.040 --> 0:03:50.240 Wars reports from that around nineteen hundred is one of 0:03:50.240 --> 0:03:54.200 these reports were all made, Yeah, a few different excerpts. 0:03:54.240 --> 0:03:55.800 I thought it was more fun to do a little 0:03:55.840 --> 0:04:00.720 smattering of harries essentially. 0:04:00.840 --> 0:04:03.400 Yes, and you'll. 0:04:03.160 --> 0:04:06.240 Hear why I picked the Spanish American War for the 0:04:06.280 --> 0:04:09.560 subject of today's episode later on. 0:04:10.080 --> 0:04:14.240 But first, Hi, I'm Aaron Welsh. 0:04:13.680 --> 0:04:15.640 And I'm Aaron Olman Updyke. 0:04:15.440 --> 0:04:17.640 And this is this podcast will kill You. 0:04:18.320 --> 0:04:20.320 And we're back with season four. 0:04:20.680 --> 0:04:26.279 We are back, and I'm very excited. 0:04:26.760 --> 0:04:28.480 I think we definitely needed. 0:04:28.200 --> 0:04:30.000 That break, oh big time. 0:04:30.480 --> 0:04:33.600 Yeah, so we appreciate you guys for being patient and 0:04:33.600 --> 0:04:37.360 sticking with us, Yes and yeah, letting us get a 0:04:37.400 --> 0:04:42.360 little bit of a time to take a breather and yeah. 0:04:41.560 --> 0:04:44.360 Well and also get a bunch of fun new episodes 0:04:44.400 --> 0:04:45.040 lined up for. 0:04:45.080 --> 0:04:46.640 Oh so many fun new episodes. 0:04:46.720 --> 0:04:46.920 Yeah. 0:04:47.080 --> 0:04:50.760 Yeah, speaking of fun new episodes, what is the topic 0:04:50.800 --> 0:04:51.719 of today's episode? 0:04:51.720 --> 0:04:53.000 Maybe our break was too long? 0:04:53.160 --> 0:04:55.640 Eric, No, No, I actually love that. I feel like 0:04:55.720 --> 0:04:58.400 most of the time lately, our first hands completely give 0:04:58.440 --> 0:05:01.039 it away, and now it's like Spence has been building 0:05:01.040 --> 0:05:01.400 for like. 0:05:01.680 --> 0:05:03.680 Two whole minutes. Yeah. 0:05:03.760 --> 0:05:06.160 Well, I guess if no one clicked on the title 0:05:06.200 --> 0:05:10.120 of the episode, maybe there's an auto played. 0:05:11.839 --> 0:05:15.440 But today we're talking about typhoid fever. 0:05:16.000 --> 0:05:17.760 Oh, typhoid fever. 0:05:18.880 --> 0:05:21.920 This one has been a long time coming, Oh, very 0:05:21.960 --> 0:05:22.760 long time coming. 0:05:23.400 --> 0:05:27.359 I am super excited to cover this one because typhoid 0:05:27.360 --> 0:05:30.560 fever was sort of the episode. I feel like that 0:05:30.640 --> 0:05:32.480 really changed our lives. 0:05:33.520 --> 0:05:36.960 Yes, it changed our lives one thousand percent, even though 0:05:37.000 --> 0:05:41.560 we have not yet covered it. Yeah, because typhoid the 0:05:41.640 --> 0:05:45.640 story of typhoid Mary is the story that Georgia Hartstark 0:05:45.720 --> 0:05:48.520 told when she first gave us a shout out on 0:05:48.640 --> 0:05:52.640 My Favorite Murder, which is like what led to like 0:05:52.960 --> 0:05:54.760 our lives changing forever. 0:05:54.760 --> 0:05:56.960 All the way back, in case you're interested in listening 0:05:57.279 --> 0:05:59.640 all the way back in episode one oh five titled 0:05:59.680 --> 0:06:02.359 per I looked it up and I listened to it again. 0:06:03.240 --> 0:06:05.440 It's for research for this episode. 0:06:08.040 --> 0:06:11.520 Yeah, yeah, this is definitely like a full circle moment. 0:06:11.720 --> 0:06:17.240 We've been waiting for this episode since like twenty eighteen eighteen, yeah, eighteen. 0:06:17.400 --> 0:06:20.360 Yeah, I'm just so excited for it. 0:06:20.480 --> 0:06:20.880 Me too. 0:06:21.440 --> 0:06:24.480 But before we get into the actual meat of the episode, 0:06:24.480 --> 0:06:28.279 we do have some pieces of business, starting. 0:06:27.839 --> 0:06:29.599 With quarantin any time. 0:06:29.920 --> 0:06:33.200 Quarantine any time, Aaron, What are we drinking this week? 0:06:33.360 --> 0:06:36.680 Of course, we could be drinking nothing other than a 0:06:36.760 --> 0:06:43.760 bloody Mary, bloody typhoid Mary, bloody typhoid Mary. Not just 0:06:43.880 --> 0:06:46.200 any bloody Mary, not just any. 0:06:46.600 --> 0:06:50.800 This one is titled differently, but yeah, other than the title, 0:06:50.880 --> 0:06:54.279 it is essentially a bloody Mary who doesn't love the 0:06:54.279 --> 0:06:57.520 bloody Mary. You can pick and choose whatever pickled vegetables 0:06:57.560 --> 0:06:59.760 you want to put in there. It's tomato juice, it's 0:07:00.160 --> 0:07:04.320 cu it's you know, worcessre sauce, it's hot sauce. It's 0:07:04.440 --> 0:07:05.760 whatever you want to put in there. 0:07:05.839 --> 0:07:08.239 It's how you like a bloody Mary? 0:07:08.640 --> 0:07:15.320 Yeah, an entire like hamburger on a on a stick. Yeah, 0:07:15.360 --> 0:07:17.280 anything you want to put in there. We will post 0:07:17.360 --> 0:07:21.280 the recipe to the bloody typhoid Mary as well as 0:07:21.320 --> 0:07:24.200 the non alcoholic plac Brita on our website this podcast 0:07:24.200 --> 0:07:26.240 will Kill You dot com, as well as on all 0:07:26.280 --> 0:07:28.000 of our social media channels. 0:07:28.360 --> 0:07:30.760 What other business do we have to attend to, Aaron. 0:07:31.160 --> 0:07:35.000 Well, let's see, let's go over the usual suspects. I mean, 0:07:35.280 --> 0:07:39.680 number one, we've got merch. We've got some super cute 0:07:39.800 --> 0:07:40.760 new things that. 0:07:40.720 --> 0:07:43.760 Are very exciting things. 0:07:43.800 --> 0:07:48.080 In fact, the amazing artist Holly Sullivan did some new 0:07:48.120 --> 0:07:51.160 designs for us, including and you can get prints of 0:07:51.160 --> 0:07:55.120 her designs right now, and stickers of your Cinea pestis 0:07:55.200 --> 0:08:03.000 eighties a jip dye of the influenza virus of Giardia. 0:08:01.320 --> 0:08:02.640 However you like to say it. 0:08:03.280 --> 0:08:05.720 And then there's also other really cool things like one 0:08:05.760 --> 0:08:08.000 of my favorites is the Quarantining Time T shirt. It 0:08:08.080 --> 0:08:11.760 is so soft and I also have to admit of 0:08:11.960 --> 0:08:15.080 to always wearing the hoodie around. 0:08:15.520 --> 0:08:16.840 It's like the perfect weight. 0:08:16.920 --> 0:08:19.560 And then I drink out of the pint glasses and 0:08:19.600 --> 0:08:21.600 the socks are just too cute. 0:08:21.640 --> 0:08:22.440 I can't handle it. 0:08:22.720 --> 0:08:26.600 We also heard you, guys when you asked for face masks, 0:08:26.760 --> 0:08:30.000 since those are now pretty much a staple of everyone's wardrobe, 0:08:30.320 --> 0:08:33.480 so we have two different face masks, including one that 0:08:33.559 --> 0:08:36.239 says wash your hands. You have filthy animals. 0:08:36.320 --> 0:08:36.880 They both do. 0:08:37.240 --> 0:08:37.960 Oh, they both do. 0:08:40.280 --> 0:08:43.560 They are super cute. I really I love them all. 0:08:43.640 --> 0:08:45.600 So yeah, go check it out. You can get to 0:08:45.640 --> 0:08:49.800 it by the This podcast will Kill You dot com website, click. 0:08:49.559 --> 0:08:54.240 On the merch tab. Yeah great, let's see. Okay, more business. 0:08:54.920 --> 0:08:57.040 We can run through the rest of the usual suspects, 0:08:57.040 --> 0:08:59.840 which includes hey, check it out. We've got a bookshop 0:09:00.480 --> 0:09:03.400 affiliate account, so if you're interested in doing any additional 0:09:03.440 --> 0:09:06.240 reading on any of the topics that we cover, we 0:09:06.600 --> 0:09:10.880 link to the books there also through our website, and 0:09:11.080 --> 0:09:13.320 we also have a good Reads list, so check it 0:09:13.360 --> 0:09:15.920 out too. Other people can add suggestions there, so you 0:09:16.000 --> 0:09:18.960 get like a whole smattering of both fiction and nonfiction 0:09:19.160 --> 0:09:20.040 disease readings. 0:09:20.040 --> 0:09:26.960 It's pretty cool, and if you would like alcohol free versions, 0:09:26.960 --> 0:09:29.160 of these episodes. Maybe you're a teacher, you want to 0:09:29.240 --> 0:09:31.520 use these for whatever reason, Maybe you just don't want 0:09:31.559 --> 0:09:33.880 to hear us talk about quarantinies. You can find those 0:09:34.080 --> 0:09:36.079 as well on our website, this podcast will Kill You 0:09:36.160 --> 0:09:36.720 dot Com. 0:09:37.280 --> 0:09:39.800 And then we have a couple of new announcements. 0:09:39.840 --> 0:09:43.000 So the first is that we are going to be 0:09:43.120 --> 0:09:47.800 picking up again our Anatomy of a Pandemic series, which 0:09:47.880 --> 0:09:52.679 covers the COVID nineteen pandemic. So we stopped releasing episodes 0:09:52.760 --> 0:09:55.560 in May, and now we are going to take some 0:09:55.640 --> 0:09:58.880 time to revisit some of these topics. You know, what 0:09:58.960 --> 0:10:01.960 have we learned so far about the virus. Everyone wants 0:10:02.000 --> 0:10:04.480 to know about the vaccine and where we stand with that, 0:10:05.320 --> 0:10:07.480 and so we are going to be putting those out 0:10:08.320 --> 0:10:11.600 as we work through these normal episodes. So don't worry, 0:10:11.600 --> 0:10:14.720 the normal episodes won't be interrupted. Yeah, and we also 0:10:14.840 --> 0:10:18.440 still have the first the COVID nineteen first hand account 0:10:18.559 --> 0:10:20.960 submission form still active, So if you would like to 0:10:21.000 --> 0:10:23.800 share your story potentially as a first hand account in 0:10:23.800 --> 0:10:26.880 one of these episodes, please head to this podcast We'll 0:10:26.960 --> 0:10:30.280 Kill You dot com and click on the COVID nineteen 0:10:30.400 --> 0:10:32.360 first hand tab at the top of the page. 0:10:32.800 --> 0:10:34.400 Is that all the things? 0:10:34.520 --> 0:10:36.679 I think that's it. I'm exhausted. 0:10:37.120 --> 0:10:40.280 All right, let's circle back around tomorrow to pick up 0:10:40.280 --> 0:10:41.160 the actual episode. 0:10:41.160 --> 0:10:43.800 A perfect good idea, good idea. 0:10:45.280 --> 0:10:47.439 Ah, but I guess yeah. 0:10:47.520 --> 0:10:49.120 Can we finally start talking about typhoid? 0:10:49.240 --> 0:10:49.440 Yes? 0:10:49.600 --> 0:10:54.319 I think we are ready. We'll take a quick break first. Great. 0:11:20.120 --> 0:11:26.839 I think this is one of the most classic and 0:11:27.040 --> 0:11:32.520 also most specific diseases that we've done in a very 0:11:32.559 --> 0:11:33.080 long time. 0:11:33.559 --> 0:11:36.240 You mean, like it's not super complicated where it has 0:11:36.320 --> 0:11:38.440 all these different norms and this and that. 0:11:38.760 --> 0:11:40.640 No, No, it's plenty complicated. 0:11:40.679 --> 0:11:45.480 Oh good, Okay, but it is a very classic TPWKY feel, 0:11:45.480 --> 0:11:47.680 which is kind of fun and why we chose to 0:11:47.679 --> 0:11:50.240 do it for our fourth season premiere exactly. 0:11:50.320 --> 0:11:54.080 It's a very classic feel. But then it's also well, 0:11:54.120 --> 0:11:56.000 I'll get into it and you'll see what I mean 0:11:56.000 --> 0:12:01.800 by specific. Okay, okay, okay. So, typhoid fever, which is 0:12:01.840 --> 0:12:06.640 also called enteric fever depending on where you live, is 0:12:06.679 --> 0:12:10.640 the disease that is caused by a gram negative rod 0:12:10.720 --> 0:12:15.240 shaped bacteria whose full name is Are you ready for this? 0:12:15.880 --> 0:12:17.280 I know you know this already, but I. 0:12:17.320 --> 0:12:20.760 Know it's a big one. It's a mouthful. 0:12:20.840 --> 0:12:29.000 Salmonilla enterica subspecies Enterica serah var typhe. And that's what 0:12:29.080 --> 0:12:30.119 I mean by specific. 0:12:30.640 --> 0:12:37.880 I don't quite understand why why Okay, this is a 0:12:37.880 --> 0:12:41.679 sarah var. Great, really great question. I'm so glad that 0:12:41.720 --> 0:12:42.520 you asked it, Darren. 0:12:43.400 --> 0:12:45.080 You know I was going to yes. 0:12:45.280 --> 0:12:47.520 So first of all, we're just gonna call it by 0:12:47.559 --> 0:12:51.600 its shorthand name, Salmonella typhee. Okay, that's how you can 0:12:51.640 --> 0:12:54.920 refer to it. Now, there are something like twenty five 0:12:55.040 --> 0:13:01.520 hundred different serovars of salmonilla, salmonilla and terica even and 0:13:01.559 --> 0:13:05.120 at least fifty of them are pathogenic, although not all 0:13:05.160 --> 0:13:09.160 of those are pathogenic to humans. So you asked, how, 0:13:09.559 --> 0:13:12.440 like what makes the serovar? You can kind of think 0:13:12.480 --> 0:13:16.160 of it like, you know how we name influenza strains 0:13:16.240 --> 0:13:19.439 by their H and their N yep. Okay, So serovars 0:13:19.480 --> 0:13:23.839 are differentiated by from each other by those specific antigens 0:13:23.840 --> 0:13:27.000 on their surface. So in the case of Salmonella, it's 0:13:27.040 --> 0:13:32.000 their lipopolysaccharide, which is an O antigen, and their flagella 0:13:32.160 --> 0:13:35.680 flagellar antigen, which is an H antigen. So that's how 0:13:35.720 --> 0:13:40.360 we identify them. You'd like to know the serovar name 0:13:40.679 --> 0:13:45.559 of salmonilla serovar type, it's O nine to twelve v 0:13:45.880 --> 0:13:52.680 IHD dash. That's an easy thing to remember, right, Yeah, Okay, 0:13:52.880 --> 0:13:55.000 So I'm going to start off with a side note. 0:13:55.679 --> 0:13:59.440 There's another serovar, a couple of other seravars actually that 0:13:59.480 --> 0:14:03.480 are called para typhee. So there's paratype A, B, and C. 0:14:04.480 --> 0:14:09.240 This serahvar causes a very similar but generally more mild illness, 0:14:09.400 --> 0:14:13.440 and so the term enteric fever usually encompasses both the 0:14:13.520 --> 0:14:19.040 diseases caused by salmonilla typhee and salmonilla paratyphee. So we're 0:14:19.080 --> 0:14:21.600 going to try and stay as specific as possible in 0:14:21.640 --> 0:14:24.960 this episode and really just focus in on salmonilla typhe 0:14:25.040 --> 0:14:25.920 or typhoid fever. 0:14:26.200 --> 0:14:27.400 Cool, gotcha Cool. 0:14:27.680 --> 0:14:31.680 So Salmonella typhe is what is referred to as a 0:14:31.720 --> 0:14:36.480 host restricted pathogen, so it primarily infects just humans and 0:14:36.520 --> 0:14:41.080 then also like chimpanzees. All right, so how is it transmitted? 0:14:41.640 --> 0:14:44.480 I know, you know, and everyone that listened to the 0:14:44.520 --> 0:14:46.240 first hand probably has a guess. 0:14:46.600 --> 0:14:48.560 I mean, if you're playing bingo with the number of 0:14:48.560 --> 0:14:56.040 times that fecal is going to be said in this episode. 0:14:53.520 --> 0:14:57.360 With a lot. Yeah, fecal oral so poop in mouth 0:14:57.440 --> 0:15:01.800 wherever poop can end up then ends up in your mouth, 0:15:01.960 --> 0:15:05.760 you can get infected. Okay. One thing that's important, and 0:15:05.800 --> 0:15:08.240 I think this is actually really interesting considering that this 0:15:08.320 --> 0:15:12.120 is a fecal oral transmitted parasite, is that Salemonella is 0:15:12.160 --> 0:15:16.800 actually really acid labile, so it does not tolerate the 0:15:16.920 --> 0:15:20.840 environment of your stomach very well at all. So that 0:15:20.920 --> 0:15:24.440 means that the infectious dose is really really high compared 0:15:24.480 --> 0:15:27.000 to a lot of other bacteria and viruses that we've 0:15:27.040 --> 0:15:28.320 talked about on this podcast. 0:15:28.680 --> 0:15:30.760 Interesting, like r how high. 0:15:30.880 --> 0:15:34.400 At least ten thousand bacteria to cause an infection and 0:15:34.520 --> 0:15:38.760 even at that number, the attack rate, so the percentage 0:15:38.760 --> 0:15:42.360 of people who would actually get like sick is low, 0:15:42.440 --> 0:15:45.320 like ten to twenty percent at that infectious dose. 0:15:45.440 --> 0:15:51.640 Okay, how much bacteria is an infected person or a carrier? 0:15:51.720 --> 0:15:52.120 Shetting? 0:15:52.400 --> 0:15:54.200 Such a good question. I don't even know if I 0:15:54.280 --> 0:15:56.440 know the answer to that. Let me scroll through my 0:15:56.560 --> 0:16:00.400 notes in an average poop in an average poop, that's 0:16:00.440 --> 0:16:03.320 a good Aaron, what a good question that I don't 0:16:03.360 --> 0:16:05.520 have the answer to in all of my notes. 0:16:06.600 --> 0:16:09.000 Just FYI, guys, we just spent a little bit of 0:16:09.040 --> 0:16:13.560 time both looking for the answer. I mean, like not 0:16:13.800 --> 0:16:15.240 that long, but you. 0:16:15.200 --> 0:16:16.960 Know, more than a few minutes. 0:16:17.360 --> 0:16:19.320 We spent more than a few minutes, and we couldn't 0:16:19.360 --> 0:16:22.560 find anything, and so we just think it's safe to 0:16:22.600 --> 0:16:23.480 assume that it's. 0:16:23.320 --> 0:16:24.280 It's probably a lot. 0:16:24.440 --> 0:16:26.720 It's not going to be like there's been a lot 0:16:26.760 --> 0:16:29.640 of typhoid fever epidemics and it's. 0:16:29.440 --> 0:16:31.720 Got to be a lot because it takes a lot 0:16:31.720 --> 0:16:34.560 to get you sick, and you poop a lot when 0:16:34.560 --> 0:16:39.480 you have typhoid fever, so uh, you know, and it's 0:16:39.480 --> 0:16:43.240 a it's a Salmonella bacteria which reproduced very quickly, so 0:16:44.280 --> 0:16:45.320 a lot a lot. 0:16:47.320 --> 0:16:49.960 Hey, if somebody can find the actual number, that would 0:16:49.960 --> 0:16:52.040 be that would be super cool. 0:16:52.160 --> 0:16:56.200 Love would love that actual number. But what I did 0:16:56.280 --> 0:17:00.000 want to say about this is that what's really interesting 0:17:00.080 --> 0:17:03.360 saying is that the smaller the infectious dose, the longer 0:17:03.520 --> 0:17:07.480 the incubation period, So the longer between when you first 0:17:07.520 --> 0:17:10.160 get exposed to when you start to show symptoms, which 0:17:10.200 --> 0:17:13.399 is logical, but it's nice when we can see that 0:17:13.560 --> 0:17:19.240 in data. Cool. Okay, Yeah, So the incubation period, that 0:17:19.359 --> 0:17:22.919 time from infection to symptoms usually is between five and 0:17:23.000 --> 0:17:25.520 fifteen days, but it can be quite a bit longer, 0:17:25.640 --> 0:17:26.840 like even a month or more. 0:17:27.200 --> 0:17:27.640 Gotcha. 0:17:27.800 --> 0:17:32.800 Okay, so let's talk about the symptoms of typhoid fever, 0:17:32.880 --> 0:17:33.240 shall we. 0:17:34.000 --> 0:17:34.800 Let's okay. 0:17:35.440 --> 0:17:38.879 The classic description goes something like this. It starts with 0:17:39.000 --> 0:17:44.480 a fever fever, but not just any fever, because we 0:17:44.560 --> 0:17:47.840 have to get specific. This is a fever that gets 0:17:47.920 --> 0:17:52.200 progressively worse. It's called a step ladder or a step 0:17:52.240 --> 0:17:57.000 wise fever. So once it begins, it remains high and 0:17:57.040 --> 0:18:01.040 then progressively rises over the course of or so weeks 0:18:01.400 --> 0:18:04.439 before it peaks, and then stays pretty high like a 0:18:04.480 --> 0:18:05.919 plateau phase. 0:18:06.560 --> 0:18:08.560 Huh okay, okay, like how high? 0:18:08.840 --> 0:18:12.760 Good question? Not bonkers high, Like, we're not talking one 0:18:12.800 --> 0:18:15.840 oh six, But a fever is classified as one hundred 0:18:15.880 --> 0:18:20.199 point four fahrenheit or thirty eight celsius. So it'll start 0:18:20.240 --> 0:18:23.040 there just like a low grade fever, and then progressively 0:18:23.240 --> 0:18:26.040 just get higher. I don't know what the maximum peak is, 0:18:26.480 --> 0:18:29.040 probably depends on the person, but we're not talking like 0:18:29.160 --> 0:18:31.680 one oh six one oh seven. It's just a slowly 0:18:31.840 --> 0:18:35.520 progressive fever. And what's important is that it stays high. 0:18:35.560 --> 0:18:38.439 A lot of other diseases you might have a fever 0:18:38.560 --> 0:18:40.240 for part of the day and then part of the 0:18:40.320 --> 0:18:43.680 day your temperature will go back down. With typhoid, once 0:18:43.760 --> 0:18:48.800 your fever rises, you stay with an elevated temperature. Okay, okay, okay. 0:18:49.040 --> 0:18:53.239 And the other classic symptom that's very interesting is that 0:18:53.680 --> 0:18:56.480 and oh my gosh, Aron, please don't ask me why 0:18:56.520 --> 0:19:01.920 this happens. Okay, just I'm forewarning you. But classic typhoid 0:19:01.960 --> 0:19:05.160 has what's called a relative brad acardia, So that means 0:19:05.160 --> 0:19:08.719 that your heart rate is slow. And normally, when you 0:19:08.800 --> 0:19:12.359 have a fever, a normal physiologic response would be your 0:19:12.400 --> 0:19:16.280 body going, hey, I'm feeling stressed out because my temperature's high, 0:19:16.440 --> 0:19:19.080 so my heart rate is going to increase because of 0:19:19.119 --> 0:19:24.040 that high temperature. But with typhoid, it doesn't do that. 0:19:24.240 --> 0:19:26.119 Your heart rate stays low. 0:19:26.600 --> 0:19:32.080 I am bursting with questions, how dare you censor me? Okay, 0:19:32.880 --> 0:19:35.960 I won't ask why, I will ask are there other 0:19:36.359 --> 0:19:40.800 diseases or other times that fever occurs when the same 0:19:40.880 --> 0:19:42.040 thing happens. 0:19:41.920 --> 0:19:44.760 There are some others. Absolutely, this isn't the only thing 0:19:44.840 --> 0:19:49.960 that causes this, but that's one of those classic findings. Okay, okay, Wow, 0:19:50.160 --> 0:19:55.840 I know Okay, all right, Now that's the initial phase. Okay, 0:19:55.880 --> 0:20:00.479 So it's like this two weeks of increasing fever. In 0:20:00.520 --> 0:20:03.520 the second week, people might start to get a faint 0:20:03.720 --> 0:20:06.960 rash on their trunk. There are these little salmon colored 0:20:07.040 --> 0:20:12.000 spots for sure. That's not why it's called salmonilla though. Okay. 0:20:14.320 --> 0:20:17.679 And then in the third week of illness, you often 0:20:17.720 --> 0:20:21.840 get abdominal pain. You can get either diarrhea or constipation, 0:20:22.000 --> 0:20:27.680 which is interesting. We'll talk more about that later, bleeding 0:20:27.720 --> 0:20:33.359 from the intestinal tract. Often you can get secondary bacterymia. 0:20:33.440 --> 0:20:36.240 So if this bacteria enters your bloodstream and starts to 0:20:36.280 --> 0:20:40.880 replicate in your bloodstream, that's what bacterymia is. And sepsis, 0:20:41.800 --> 0:20:47.720 almost everyone will get hepatitis and a painful hippatosplinomegaly, which 0:20:47.760 --> 0:20:49.840 is a fun word we often say on this podcast. 0:20:49.840 --> 0:20:52.840 So swelling of your liver and spleen. And now this 0:20:53.040 --> 0:20:55.159 I want to put a pin in so that you 0:20:55.200 --> 0:20:57.080 remember it because we're going to talk more about it. 0:20:57.520 --> 0:21:02.080 But salmonilla typhee is also a cause of acute coly 0:21:02.200 --> 0:21:10.320 cystitis aka gallbladder infection. Okay, that's important. Just remember it now. 0:21:11.200 --> 0:21:14.359 This is not a bacteria that tends to infect your 0:21:14.480 --> 0:21:20.240 nervous system, so neurologic manifestations are pretty uncommon. It's not impossible, 0:21:20.480 --> 0:21:22.920 but when you have them, they look more like febrile 0:21:23.080 --> 0:21:26.000 seizures and young children, which happens with a whole bunch 0:21:26.040 --> 0:21:30.160 of different diseases. And then it is possible to have 0:21:30.320 --> 0:21:35.320 other more serious complications like myocarditis, but this is really rare, 0:21:35.359 --> 0:21:37.320 so that would be if it infects your heart. But 0:21:37.560 --> 0:21:42.360 most of the time this is a gastrointestinal tract disease. 0:21:43.600 --> 0:21:48.800 So if you don't die from overwhelming sepsis and shock 0:21:49.600 --> 0:21:54.000 or from your intestines becoming perforated and just like exploding 0:21:54.040 --> 0:21:59.040 your gut juices everywhere, my god, then over a period 0:21:59.080 --> 0:22:03.240 of weeks to months, your symptoms gradually begin to resolve. 0:22:04.760 --> 0:22:08.560 If you do not die, okay, over a period of 0:22:08.600 --> 0:22:09.960 weeks to months. 0:22:10.040 --> 0:22:16.960 Weeks two months. This is a long lasting infection. So 0:22:17.680 --> 0:22:21.600 the big question in my mind is what makes Salmonella 0:22:21.680 --> 0:22:25.159 typhe so different from all the other serivars of salmonella 0:22:25.280 --> 0:22:29.400 and enterica. Right, A lot of other species of salmonilla, 0:22:29.680 --> 0:22:33.320 even salmonilla in terica, can infect us and maybe we 0:22:33.359 --> 0:22:37.920 get like the poops from it. But Salmonella typhee causes 0:22:37.960 --> 0:22:43.639 this really disseminated infection. It's mostly GI symptoms, but the 0:22:43.680 --> 0:22:46.159 first symptoms that you see are this fever, which tells 0:22:46.240 --> 0:22:48.600 us that it's affecting a lot more than just our 0:22:48.640 --> 0:22:55.960 GI tract. Yeah, so why Yeah, I ask myself the 0:22:56.040 --> 0:23:03.239 questions that I can answer. So the difference really is 0:23:04.080 --> 0:23:08.560 because Salmonella typhe is this host restricted pathogen. It can 0:23:08.680 --> 0:23:13.800 very quickly invade through our gastrointestinal walls, so it is 0:23:13.880 --> 0:23:17.480 not limited. It's not causing an infection that's only in 0:23:17.520 --> 0:23:23.879 our GI tract. Exactly how this happens, we still don't 0:23:23.920 --> 0:23:28.560 fully know, but we do know that it's at least 0:23:28.600 --> 0:23:33.720 in part due to the bacteria down regulating our immune response. 0:23:34.640 --> 0:23:38.760 So here's where it gets interesting. Okay, in our GI tract, 0:23:39.200 --> 0:23:42.480 we have these things called pyre's patches. I feel like 0:23:42.520 --> 0:23:44.879 we've talked about them a little bit on this podcast before, 0:23:45.119 --> 0:23:48.159 but they're basically like lymph nodes in the walls of 0:23:48.200 --> 0:23:50.359 our small intestine. So it's where like our white blood 0:23:50.359 --> 0:23:55.080 cells hangout. It's like the immune center of our GI tract. 0:23:55.240 --> 0:23:58.080 Our GI tract has its own little immune system. 0:23:58.359 --> 0:24:00.680 Oh, it's like a big deal. 0:24:01.040 --> 0:24:05.560 It's a very big deal. Yeah, it's very cool. So 0:24:06.880 --> 0:24:12.919