Typhoid Fever

What is typhoid fever?

Typhoid fever is a life-threatening bacterial infection caused by the bacterium Salmonella enterica serotype Typhi (S. typhi). According to the CDC, typhoid fever affects about 22 million people in the world each year. The incidence of typhoid fever in U.S. citizens and residents is low, with the majority of cases being acquired while traveling internationally. 

How is typhoid fever spread?

S. typhi live only in humans, and are carried in the bloodstream and intestinal tracts of people who have typhoid fever. A small number of people recover from typhoid fever but continue to carry the bacteria.

Both the carriers and the people who have active typhoid fever shed S. typhi in their stools. Typhoid fever is spread by consuming food or beverages that have been handled by a person who is shedding S. typhi, or if sewage contaminated with S. typhi bacteria gets into water used for drinking or washing food.

What are the symptoms of typhoid fever?

When S. typhi bacteria are consumed, they multiply and spread into the bloodstream. Symptoms may not develop for six to 30 days after initial exposure. 

The body reacts with signs and symptoms such as:

  • A sustained fever as high as 102 to 104 degrees Fahrenheit (39 to 40 degrees Celsius)

  • Weakness

  • Stomach pains

  • Headache

  • Loss of appetite

  • Sometimes a rash of flat, rose-colored spots

The symptoms of typhoid fever may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is typhoid fever diagnosed?

Typhoid fever can be diagnosed using a blood test or stool sample to determine the presence of S. typhi bacteria. However, the accuracy of these tests is variable, particularly during the acute phase of the disease. Subsequently, clinical signs and symptoms, as well as travel history, have to be considered when making the diagnosis.  

How can typhoid fever be prevented?

A vaccination for typhoid fever is available. However, it can lose effectiveness after several years, so a booster vaccination may be necessary.

Other preventive measures for travelers to high-risk areas include the following:

  • Only use water that has been boiled or chemically disinfected for:

    • Drinking, or preparing beverages, such as tea or coffee

    • Brushing teeth

    • Washing face and hands (can also use alcohol-based gel to wash hands)

    • Washing fruits and vegetables

    • Washing eating utensils and food preparation equipment

    • Washing the surfaces of tins, cans, and bottles that contain food or beverages

  • Do not eat food or drink beverages from unknown sources

  • Do not put ice in drinks

  • Avoid eating food from street vendors 

  • Any raw food could be contaminated and should be avoided, including:

    • Fruits and vegetables, particularly those that cannot be peeled 

    • Salad greens 

    • Unpasteurized milk and milk products

    • Raw meat

    • Shellfish

    • Any fish caught in tropical reefs rather than the open ocean

Taking antibiotics is not a preventive for typhoid fever.

Treatment for typhoid fever

See your doctor immediately if you think you have been exposed to typhoid fever. People who do not get treatment may continue to have fever for weeks or months, and may eventually die from complications. Treatment will probably include an antibiotic to treat the disease. Specific treatment for typhoid fever will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

It is important to remember that the danger of typhoid fever does not end when symptoms disappear. You could still be carrying S. typhi and the illness could return, or you could pass the disease to other people. People who have typhoid fever should:

  • Take any prescribed antibiotics.

  • Wash their hands after using the bathroom

  • Have a series of stool cultures (to ensure that the S. typhi bacteria are no longer present)

Typhoid fever and the traveler

Typhoid fever is very common in developing countries. Travelers to Asia (except Japan), Africa, and Latin America are especially at risk. The CDC recommends avoiding risky food or drink and considering vaccination one to two weeks before traveling to an area where typhoid fever is common.