Typhoid Fever

Typhoid fever is an illness caused by Salmonella typhi (S. typhi) bacteria. It causes a high fever that can last for weeks, belly pain, diarrhea and vomiting. It can lead to serious complications without treatment.

Some people continue to be contagious with typhoid fever even after they’ve recovered. You can spread the bacteria for a year or more with no symptoms. It’s important to get tested after you feel better to make sure you can’t spread it to other people.

S. typhi is different from the Salmonella bacteria that cause salmonellosis, a common type of food poisoning. Typhoid fever is also called enteric fever.

Symptoms of typhoid fever

Typhoid symptoms can appear over a few weeks. They include:

• Fever that gradually gets worse over several days
• Headache
• Chills
• Loss of appetite
• Stomach (abdominal) pain
• “Rose spots” rash, or faint pink spots, usually on your chest or stomach — these can be hard to see on dark skin tones
• Cough
• Muscle aches
• Nausea, vomiting
• Diarrhea or constipation

Fever is often the first symptom. It can last several weeks without treatment.

Typhoid fever causes

Typhi bacteria cause typhoid. They live in the gut (intestines) of infected people. They can also live in your gallbladder without causing symptoms. This means you may still be contagious even after you feel better.

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
• Waste water (water that has poop or pee in it) gets into water you drink or on food you eat

It can also happen if someone with typhoid doesn’t wash their hands after going to the bathroom, then touches surfaces and objects (like phones or doorknobs). This can leave bacteria behind that can infect the next person who touches them.

Risk factors

Typhoid fever is most common in rural areas of countries that don’t have access to clean water. It’s most common in:

• Africa
• The Caribbean
• Central and South America
• South and Southeast Asia, especially Pakistan, India and Bangladesh

Children are more likely to get typhoid than adults.

Complications

If you’re not treated with antibiotics, typhoid can cause severe organ damage. This usually happens after a week or two of symptoms.

Complications include:

• Bronchitis, pneumonia or other respiratory issues
• Bone inflammation (osteomyelitis)
• Heart inflammation
• Hole (perforation) in your intestines
• Inflammation in and around your brain (encephalitis or meningitis), which can cause confusion, delirium and seizures
• Internal bleeding
• Kidney failure
• Swollen or burst gallbladder

If you’re pregnant and have typhoid, it can cause a miscarriage.

How doctors diagnose typhoid fever

Your healthcare provider will use your symptoms, travel history and lab tests to diagnose typhoid fever. It’s very important to tell your provider if you’ve traveled recently or think you’ve been exposed to typhoid. This lets them know they should test for it. They’ll also use the information to decide what treatment to give.

A provider will take samples of body fluids or tissue to test for signs of S. typhi. They might take samples of your:

• Blood
• Poop (stool)
• Pee (urine)
• Skin
• Bone marrow

They may also get X-rays to look for changes in your lungs.

How is typhoid fever treated?

Providers treat typhoid fever with antibiotics. Some newer types of the bacteria are able to survive antibiotic treatments. Your provider will treat you with different antibiotics depending on the type of typhoid you have and where you got sick.

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

Recovery time

If you’re treated early with an antibiotic, you should start to feel better in a few days. It’s important to take all your medications as directed, even if you start to feel better. It might take a week to 10 days to feel completely recovered. If you don’t treat it or if treatment starts later, typhoid can last three weeks or longer.

When should I see my healthcare provider?

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

If you’ve recovered and your symptoms return, see your provider. You’ll need another course of antibiotics to reduce your risk of serious complications.

Go to the ER if you have:

• High fever
• Bloody or tarry poop (stool)
• Severe stomach pain
• Coughing up or vomiting blood
• Confusion
• Seizures

What can I expect if I have typhoid?

Typhoid fever can be very serious. But if you’re treated early, you’re less likely to get severely ill. You may feel better in as little as a few days after starting antibiotics. It’s important to know that you may still be able to spread typhoid to others for a long time after your symptoms go away.

Once you’ve recovered, 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.

Some people with typhoid fever get sick again (relapse) after they feel completely better. It usually happens about a week after finishing antibiotics. But in a few cases, it’s happened several weeks or months later. Your symptoms will probably be milder than the first time you had typhoid. Call your healthcare provider immediately if symptoms return.

Can typhoid be cured completely?

Yes, most people are eventually cured of typhoid with treatment. But unlike most other illnesses, you can still be contagious even when you no longer have symptoms.

A small percentage of people who’ve recovered is 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.

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.

How can I prevent 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. You can get a vaccine in pills you swallow or a shot. Depending on the type you get, you’ll need to get them one to two weeks before you travel.

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, use bottled water for drinking and cooking.

What’s the difference between typhoid and typhus?

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

What’s paratyphoid fever?

Paratyphoid fever is similar to typhoid with milder symptoms. It’s caused by Salmonella paratyphi bacteria. It’s treated with antibiotics.

Who was Typhoid Mary?

Mary Mallon was a cook in New York in the late 1880s. She was a carrier — not sick with typhoid fever, but still able to spread it 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. She 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.”