An Overview of Typhoid Fever

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Typhoid fever is a bacterial disease that’s spread through food, water, or person-to-person contact. The disease causes flu-like symptoms that can become life-threatening if not treated.

You’re more likely to get typhoid fever if you travel to developing areas where the disease is prevalent, such as parts of South Asia, Africa, the Caribbean, and Central and South America. The Centers for Disease Control and Prevention estimates that typhoid fever affects 5,700 in the U.S. every year, while worldwide, it may affect 11 to 21 million people.

Symptoms

The most common symptoms of typhoid fever are  :

  • Fever that can be as high as 103 to 104 degrees
  • Weakness
  • Stomach pain
  • Headache
  • Diarrhea or constipation
  • Cough
  • Loss of appetite
  • Possibly a rash of flat, rose-colored spots

If the disease progresses, it can lead to more serious symptoms, including:

  • Extreme fatigue
  • Breathlessness
  • Irregular heartbeat
  • Vomiting blood and bloody stools
  • Dark, tar-like stools
  • Severe abdominal pain and rigidity
  • Loss of consciousness and other neurological signs
  • Shock

Contact your doctor immediately if you have these symptoms, especially if you’ve recently traveled to another country. Without treatment, typhoid fever can lead to life-threatening complications, including intestinal perforation, where a hole forms in the digestive system, spreading the infection to other organs.

Causes

Typhoid fever is caused by the bacteria Salmonella Typhi, which only infects people, not animals. It can be spread through contaminated food and water as well as through contact with someone who has the illness.

The main ways you can get typhoid fever include: 

  • Drinking water that contains sewage with the Salmonella Typhi bacteria
  • Eating food that was washed with contaminated water
  • Eating or drinking something that was prepared or served by someone who has the bacteria, especially if they didn’t wash their hands after going to the bathroom. Salmonella Typhi can be found in the stool of people who are currently ill or those are asymptomatic but still carriers of the disease.

Typhoid Mary

In the early 20th century, Mary Mallon, known as “Typhoid Mary,” was an asymptomatic carrier of typhoid fever. She worked in the U.S. as a cook and transmitted the disease to more than 50 people before being forced into quarantine after she refused to heed warnings from public health officials.

Diagnosis

You doctor may suspect you have typhoid fever based on your travel history as well as your symptoms. The only way to confirm the diagnosis is by testing a sample of your blood or stool for the bacteria.

Other tests include a serology test called the Widal test and molecular tests (PCR).

They may also order a test to see if the bacteria are resistant to some antibiotics to help determine the best medication to use.

Treatment

Typhoid fever is treated with antibiotics, including ceftriaxone, ciprofloxacin), levofloxacin, and azithromycin.  The type of antibiotic you receive may depend on where you were infected and the level of antibiotic resistance in that bacterial strain.

You should take the antibiotic for the entire length of time that your doctor recommends. Always wash your hands with soap and water after going to the bathroom to avoid spreading the disease, and don’t prepare or serve meals for others until your doctor says it’s OK to do so.

With antibiotic treatment, your fever will typically last three to five days, rather than weeks or months, and the risk of death is reduced from 12% to less than 1%. 

In around 5% of patients, a relapse can occur.

Prevention

Two vaccines are available in the United States for typhoid fever: an oral vaccine and an injected vaccine. If you are traveling to a developing country where typhoid fever may be a problem, see your healthcare provider to ask about getting a vaccination.

Vaccines can help prevent most cases of typhoid fever. However, the vaccine isn’t 100% effective. Safe eating and drinking practices are necessary when traveling to a country where infection with typhoid and other microbes is a possibility. That can include drinking water only when it’s bottled or boiled, only eating foods that are thoroughly cooked and hot, asking for drinks without ice, and avoiding raw fruits and vegetables. In addition, always wash your hands with soap and water before eating.

A Word From Verywell

Typhoid fever can be a dangerous disease if not treated promptly. See your doctor if you have any concerns that you might have contracted typhoid fever, especially if you’ve recently traveled to another country. Your doctor can prescribe antibiotics to help you recover quickly and avoid spreading the disease to others.

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Article Sources
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  1. Centers for Disease Control and Prevention. Typhoid Fever and Paratyphoid Fever. Updated August 22, 2018. 

  2. UK National Health Service. Complications: Typhoid Fever. Updated June 18, 2018.

  3. Bush L. Typhoid Fever. Merck Manual Consumer Version. Updated May 2018. 

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