Typhoid Fever

What is typhoid fever?

Typhoid fever is an illness caused by the bacterium Salmonella Typhi (S. Typhi). It infects your small intestines (gut) and causes high fever, stomach pain and other symptoms. Typhoid fever is also called enteric fever.

You’ll commonly hear paratyphoid fever mentioned along with typhoid. Paratyphoid fever is similar to typhoid with more mild symptoms. It’s caused by Salmonella Paratyphi (S. Paratyphi).

S. Typhi and S. Paratyphi are different than the Salmonella bacteria that cause salmonellosis, a common type of food poisoning.

Who does typhoid fever affect?

Typhoid fever is most common in rural areas of developing countries where there isn’t modern sanitation. Countries in South and Southeast Asia, Central and South America, Africa and the Caribbean are most affected by typhoid. Travelers are most at risk when visiting Pakistan, India or Bangladesh.

Children are more likely to get typhoid than adults.

How common is typhoid fever?

It’s estimated that 11 million to 21 million people around the world get typhoid each year. It’s rare in the U.S., Canada, Japan, Western Europe and Australia.

What’s a long-term carrier of typhoid fever?

Some people continue to be contagious with typhoid fever even after they’ve recovered (long-term carrier). You can spread typhoid for a year or more with no symptoms. It’s important to get tested for S. Typhi after you feel better to make sure you can’t spread it to other people.

What’s the difference between typhoid and typhus?

While the names sound the same, typhoid and typhus are different illnesses, caused by different bacteria. The symptoms are similar — so much so that doctors used to think they were the same illness. We now know they’re different illnesses, but the similar name stuck (and so did the confusion it causes).

What are the symptoms of typhoid fever?

Typhoid fever gets its name from a high fever that can last for weeks if left untreated. It often gets progressively worse over a few days.

Other symptoms of typhoid fever include:

• Headache.
• Chills.
• Loss of appetite.
• Stomach (abdominal) pain.
• “Rose spots” rash, or faint pink spots, usually on your chest or stomach.
• Cough.
• Muscle aches.
• Nausea, vomiting.
• Diarrhea or constipation.

What causes typhoid fever?

Typhoid fever is caused by the bacterium S. Typhi. It lives in the gut (intestines) of infected people and can contaminate food and water.

How does typhoid fever spread?

Typhoid fever usually spreads through food or water contaminated with S. Typhi. This can happen if someone with typhoid touches something you eat or drink without washing their hands. It can also happen if waste water (water that has poop or pee in it) gets into water you drink or on food you eat.

You can get typhoid from another person if they don’t wash their hands after going to the bathroom. When they touch surfaces and objects (like phones or doorknobs) they can leave bacteria behind that can transfer to the next person who touches it.

Does typhoid spread by kissing?

No, typhoid doesn’t spread by kissing. You usually don’t get typhoid fever directly from another person. But you can get it if you touch something they’ve touched if they don’t wash their hands after going to the bathroom.

What are the stages of typhoid fever?

You can develop symptoms of typhoid fever gradually in four stages. Early treatment with antibiotics can keep you from progressing to later stages.

• Stage 1. You can start getting typhoid symptoms anywhere from five to 14 days after coming in contact with S. Typhi. The first symptom is a fever that gets higher over a few days — called “stepwise” since it goes up in steps. The bacteria is moving into your blood in this stage.
• Stage 2. Around the second week of fever, the bacteria is multiplying in your Peyer’s patches (part of your immune system that identifies harmful invaders). You’ll start experiencing abdominal pain and other stomach symptoms, like diarrhea or constipation. You might get “rose spots,” small pink dots on your skin that look like a rash.
• Stage 3. If not treated with antibiotics, the bacteria can cause severe damage, usually around the third week after your symptoms start. Some people get serious complications, like internal bleeding and encephalitis (inflammation in your brain).
• Stage 4. Stage four is when most people begin to recover. Your high fever begins to come down. S. Typhi can live in your gallbladder without causing symptoms, which means you may still be contagious even after you feel better.

How is typhoid fever diagnosed?

Your healthcare provider will use your symptoms, your travel history and lab tests to diagnose typhoid fever. They’ll give you a physical exam and listen to your heart and lungs.

It’s very important to tell your provider if you’ve traveled recently or think you’ve been exposed to typhoid, otherwise they might not know to test for it. They’ll also use the information to decide what treatment to give.

What tests can be done to diagnose typhoid fever?

Your healthcare provider will take samples of body fluids or tissue to test for signs of S. Typhi. They might take samples of your:

• Blood. Your provider will use a needle to take a small tube of blood from your arm.
• Poop (stool). Your healthcare provider will give you a sterile container and instructions on how to collect a sample.
• Pee (urine). You may be asked to pee into a cup given to you by your healthcare provider.
• Your provider might numb your skin and take a sample with a small razor or scalpel.
• Bone marrow. Your provider will numb your skin and use a special needle to get a sample of the inside of your bones. It’s rare that you’d ever need this test for diagnosis.

You provider may also take X-rays (pictures of the inside of your body) to look for changes in your lungs.

What is the treatment for typhoid fever?

Typhoid is treated with antibiotics. Some newer types of the bacteria are able to survive antibiotic treatments, so you’ll be treated with different antibiotics depending on what type of typhoid you have and where you got sick. Paratyphoid fever is also treated with antibiotics.

If you’re severely ill or have complications, you might need additional treatments. You’ll probably need to be admitted to the hospital for these treatments.

What medications are used to treat typhoid fever?

Your healthcare provider will treat typhoid fever with antibiotics, which may include:

• Ciprofloxacin, levoflaxin or ofloxacin.
• Ceftriaxone, cefotaxime or cefixime.
• Azithromycin.
• Carbapenems.

If your case is severe, you may be treated with steroids, like dexamethasone.

Antibiotic resistance in typhoid

Bacteria like S. Typhi can sometimes develop resistance to medications. This means that antibiotics don’t work to destroy them anymore (antibiotic resistance).

Many cases of typhoid can’t be destroyed by antibiotics we once used, but some drugs still work on them. Some are extremely drug resistant (XDR typhoid) and only a few antibiotics still work on them. This is one of the reasons that getting vaccinated to prevent typhoid is so important.

Health officials are concerned that we may no longer be able to treat typhoid if available medicines stop working. You’ll be treated with an antibiotic that works on the kind of typhoid you have based on the results of strain testing.

How do I take care of myself with typhoid fever?

To take care of yourself, make sure you finish all of your medicines as prescribed by your healthcare provider. Ask your provider if it’s safe to take non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil® or Motrin®), naproxen sodium (Aleve®) or acetaminophen (Tylenol®) for pain or fever.

How soon after treatment for typhoid fever will I feel better?

If you’re treated early with an antibiotic, you should start to feel better in a few days. It might take a week to 10 days to feel completely recovered.

How can I reduce my risk of typhoid fever?

The best way to reduce your risk of typhoid fever is to get vaccinated if you live in or are traveling to an area where it’s common. Hand washing and safe food handling are also important for limiting the spread of typhoid.

Vaccines for preventing typhoid fever

There are two vaccines for typhoid fever. They don’t last forever — you need to get additional doses to stay protected. They greatly reduce your risk but don’t guarantee you won’t get typhoid. Vaccines may provide some protection against paratyphoid fever, though this hasn’t been tested.

• Oral vaccine. The oral vaccine for typhoid is four pills that you take every other day. As of December 2020, it’s no longer available from the manufacturer.
• Injectable vaccine (shot). The injectable vaccine for typhoid is a single shot. You need to get it at least two weeks before you arrive in an area where typhoid is common so your body has time to build up defenses (make antibodies). Children over 2 years old can get the typhoid shot. You’ll need to get a booster shot every two years to stay protected.

Safe food practices for preventing typhoid fever

Vaccines are the best way to protect yourself from typhoid. But you should also take steps to avoid eating or drinking things that could be contaminated with S. Typhi or other bacteria. This is true both at home and when you’re traveling. Safe food handling practices include:

• Don’t make food for others if you’re sick.
• Wash your hands with soap and water before and after preparing food or eating and after going to the bathroom.
• Wash surfaces and utensils used for food prep and eating before and after use.
• If you’re unsure whether the food you’re eating is safe, eat mostly well-cooked or packaged food.
• Don’t drink untreated water or eat food prepared with untreated water. If you’re unsure, it’s safest to use bottled water to drink and cook with.

What can I expect if I have typhoid fever?

Depending on how soon you’re treated for typhoid, you can feel better in as little as a few days after starting antibiotics. It’s important to finish all of your medications as directed, even if you start to feel better. You may still be contagious for a long time after your symptoms go away.

Typhoid fever can be very serious. If you get treated as soon as possible, you’re less likely to have severe complications.

Typhoid relapse

Some people with typhoid fever get sick again after they seemed to be fully recovered. This is called relapse. It usually happens about a week after finishing antibiotics, but in a few cases it’s happened weeks or months later. Your symptoms will probably be milder than the first time you had typhoid.

Call your healthcare provider immediately if your symptoms return. You’ll probably have to take another course of antibiotics.

Complications of typhoid

If typhoid is left untreated, you’re at risk for severe complications, including:

• Internal bleeding.
• Intestinal perforation (a hole in your intestines).
• Swollen or burst gallbladder.
• Neurological (brain) symptoms, including confusion, delirium and seizures.
• Swelling around your brain (meningitis).
• Bronchitis, pneumonia or other respiratory issues.
• Bone inflammation (osteomyelitis).
• Heart inflammation.
• Kidney failure.
• Miscarriage.

How long does typhoid fever last?

Typhoid fever lasts seven to 10 days when treated soon after symptoms start. If untreated or if treatment starts later, it can last three weeks or longer. If you have complications or a relapse, it can take longer than that to fully recover.

Is typhoid fever fatal?

Typhoid can be fatal if not treated quickly. But with modern medicines, most people survive and fully recover. Out of the millions of people diagnosed with typhoid fever each year, about 1% to 2% of cases are fatal.

When can I go back to work or school after having typhoid fever?

Depending on where you work, you may not be able to go back until you test negative for S. Typhi. Even if you feel better, you could still spread typhoid to other people. Check with your employer or school to know what you need to do to return.

Can you still be contagious with typhoid fever after you get better?

Yes, unlike most other illnesses, you can still be contagious with typhoid even when you no longer have symptoms. About 5% of people who have recovered from typhoid fever are still contagious a year later or longer. This is called a long-term carrier. It’s important to be tested after you feel better to make sure you can’t give typhoid to someone else.

How do I take care of myself?

Once you’ve recovered from typhoid fever, it’s important to check in with your healthcare provider for follow-up. You should be tested to make sure you’re no longer contagious. Be on the lookout for symptoms of relapse.

If you have a relapse or are still contagious, you may need additional treatment with antibiotics.

When should I see my healthcare provider about typhoid fever?

If you live in or have recently visited an area where typhoid is common and have symptoms of typhoid, see your healthcare provider right away. You’re most likely to recover quickly if you’re treated early.

When should I go to ER?

Go to the ER immediately if you have:

• High fever.
• Bloody or tarry poop (stool).
• Severe stomach pain.
• Coughing up or vomiting blood.
• Neurological symptoms like confusion or seizures.

What questions should I ask my doctor?

• How do I take my prescribed medication?
• What can I use to treat my symptoms at home?
• When should I follow up with you?
• How do I prevent spreading typhoid?
• What signs of relapse should I look for?
• How and when should I be tested again after recovering?
• Should people close to me get vaccinated for typhoid?

Who was Typhoid Mary?

Mary Mallon was a cook in New York in the late 1880’s. She was not sick with typhoid fever but instead was a carrier who could still spread the disease to others. As a danger to public health, the state of New York quarantined Mallon. They told her she couldn’t work as a cook anymore.

Mallon didn’t understand how she could spread disease without being sick and continued to work as a cook after her first quarantine. She was responsible for over 100 people getting sick with typhoid fever and at least five deaths. She’s thought to be the source of an outbreak of 3,000 cases of typhoid in New York. She was quarantined a second time, for the rest of her life, and has since been known as “Typhoid Mary.”

How did countries get rid of typhoid fever?

It once caused deadly outbreaks, but typhoid fever is now uncommon in many places, including the U.S., Canada, Australia and Western Europe. This is because of modern sanitation practices. Clean water for cooking and drinking is widely available, even in rural areas.

A note from Cleveland Clinic

Typhoid fever may seem like a plague of the past, but people all over the world still get very sick from it. If you live in or are traveling to an area where typhoid is common, getting vaccinated is the best way to keep from getting ill and spreading disease.

If you think you could have typhoid, see your healthcare provider right away. If you’ve recovered from typhoid, don’t be like Mary: get tested to make sure you can’t unknowingly spread disease to others.