What is typhoid fever?
Typhoid fever is a bacterial infection that can be life-threatening. Most cases of typhoid fever occur in developing nations. However, the disease can occur anywhere, including industrialized countries like the U.S.
Who is most at risk for getting typhoid fever?
Individuals are most at risk for the disease in developing nations where good sanitation is lacking and people have limited access to clean water and safe foods. These areas are primarily in parts of Asia, Central and South America, Africa, and the Caribbean. Typhoid fever is less common in industrialized nations like the U.S. Most cases of typhoid fever in developed countries occur in returning travelers who can spread the illness to others or in contaminated foods. It is estimated that approximately 5,700 cases occur each year in the U.S. (but only 400 are confirmed).
Symptoms and Causes
What causes typhoid fever?
The bacterium Salmonella typhi (S. typhi) causes typhoid fever. The bacteria spreads through contaminated food, drink, or water. People infected with Salmonella typhi carry the bacteria in their intestinal tract and blood.
Salmonella typhi is shed (discarded from the body) in feces (stool). You may get typhoid fever if you ingest food or beverages prepared by someone who is shedding the bacteria and who does not wash their hands properly. In less developed countries, sewage containing Salmonella typhi may contaminate local water supplies.
In some cases, people who have previously had typhoid fever still carry Salmonella typhi bacteria. These people are carriers of the disease. They may spread the infection even when they have no symptoms (the famous case of “Typhoid Mary” in the U.S.).
What are the symptoms of typhoid fever?
As typhoid fever gets worse, symptoms often include:
- High fever of up to 104 degrees Fahrenheit
- Abdominal pain, constipation then perhaps diarrhea later
- Small, red spots on your abdomen or chest (rose-colored spots)
- Loss of appetite and weakness
Other symptoms of typhoid fever include:
- Body aches
- Bloody stools
- Severe fatigue
- Difficulty paying attention
- Agitation, confusion, and hallucinations (seeing or hearing things that are not real)
Diagnosis and Tests
How is typhoid fever diagnosed?
Doctors use a simple blood or stool test to diagnose typhoid fever. This test identifies the presence of Salmonella typhi in blood or stool samples.
In the U.S., doctors may not consider typhoid fever at first because it is uncommon. It’s important to tell your doctor if you have traveled to an area where typhoid fever could be present or if you think you’ve been exposed to someone who could have the infection.
Management and Treatment
How is typhoid fever treated?
Antibiotics are used to treat typhoid fever. These medications kill the bacteria that cause the infection. Several different types of antibiotics are used to treat typhoid fever. In many cases, typhoid fever is treated with ampicillin, chloramphenicol, or cotrimoxazole (Bactrim®). However, doctors also use fluoroquinolones (including Cipro® and Levaquin®), cephalosporins (including Cefepime®), and azithromycin.
Your doctor will choose based on the most up-to-date recommendations. Antibiotics are widely available in the United States and in most other countries in the world. Do not attempt to self-treat with leftover antibiotics.
Some people need supportive therapies, such as fluid or electrolyte replacement, depending on the severity of the infection.
What complications are associated with typhoid fever?
People who do not receive treatment for typhoid fever may have symptoms of the disease for months. In those cases, complications, like kidney failure or intestinal hemorrhage (severe bleeding), are possible. In severe cases, typhoid fever is fatal if left untreated. They may also become carriers and spread the illness to others.
Can typhoid fever be prevented?
If you are traveling outside the U.S., you can lower your risk of contracting the disease by:
- Receiving a typhoid fever vaccination. Currently, two vaccines are available to help prevent the spread of typhoid fever. Talk with your doctor about getting vaccinated.
- Avoiding food that is raw or undercooked
- Drinking only bottled water or water that has been boiled
- Thoroughly washing your hands each time before eating
- Avoiding raw fruits and vegetables that cannot be peeled.
- Avoiding eating foods and beverages purchased from street vendors.
Outlook / Prognosis
What is the prognosis (outlook) for people with typhoid fever?
For most people who receive treatment with antibiotics, typhoid fever symptoms improve within 2 to 4 weeks. Your symptoms may return if you do not finish your entire treatment that your doctor recommends.
When should I call my doctor?
If you develop any of the symptoms of typhoid fever or your condition does not improve, contact your doctor immediately. He or she can evaluate you to determine if you are infected. If you are traveling outside the U.S. and develop any of the symptoms of typhoid fever, contact that country’s U.S. consulate for a list of recommended doctors.