Learn more about the symptoms, cause and treatment of this serious bacterial infection.
Typhoid fever, also called enteric fever, is caused by salmonella bacteria. Typhoid fever is rare in places where few people carry the bacteria. It also is rare where water is treated to kill germs and where human waste disposal is managed. One example of where typhoid fever is rare is the United States. Places with the highest number of cases or with regular outbreaks are in Africa and South Asia. It is a serious health threat, especially for children, in places where it is more common.
Food and water with the bacteria in it cause typhoid fever. Close contact with a person who is carrying the salmonella bacteria also can cause typhoid fever. Symptoms include:
Most people who have typhoid fever feel better about a week after they start treatment to kill bacteria, called antibiotics. But without treatment, there is a small chance of death from typhoid fever complications. Vaccines against typhoid fever can provide some protection. But they can't protect against all cases of illness caused by other strains of salmonella. Vaccines can help lower risk of getting typhoid fever.
Symptoms are likely to start slowly, often showing up 1 to 3 weeks after exposure to the bacteria.
Early symptoms include:
People also may have a cough, loss of appetite and sweating.
A few weeks after symptoms start, the illness can cause problems in the intestines. People may have:
In very serious cases, people may:
These are life-threatening complications.
In some people, symptoms may return up to a few weeks after the fever has gone away.
See a health care provider right away if you think you might have typhoid fever.
If you get sick while traveling in a foreign country, know who to call for a list of providers. For some that might be the closest embassy or consulate.
If you have symptoms after you return home, consider seeing a provider who focuses on international travel medicine or infectious diseases. This might help get typhoid fever diagnosed and treated more quickly.
A bacteria strain called Salmonella enterica serotype typhi causes typhoid fever. Other strains of salmonella bacteria cause a similar disease called paratyphoid fever.
People pick up the bacteria most often in places where outbreaks are common. The bacteria passes out of the body in the stool and urine of people who are carrying the bacteria. Without careful hand-washing after going to the bathroom, the bacteria can move from the hands to objects or other people.
The bacteria also can spread from a person who carries the bacteria. It can spread on food that isn't cooked, such as raw fruits without a peel. In places where water isn't treated to kill germs, you can pick up the bacteria from that source. This includes drinking water, using ice made from untreated water, or by drinking unpasteurized milk or juice.
Even after antibiotic treatment, a small number of people who recover from typhoid fever still have the bacteria living in their bodies. These people are known as chronic carriers. They no longer have symptoms of the disease. But they still shed the bacteria in their stools and spread it.
Typhoid fever is a serious worldwide threat and affects millions of people each year. Places with the highest number of cases or with regular outbreaks are in Africa and South Asia. But cases are recorded worldwide, often due to travelers to and from these areas.
If you live in a country where typhoid fever is rare, you're at increased risk if you:
Typhoid fever complications can include damage and bleeding in the intestines. Typhoid fever also can cause cells in the walls of the small intestine or large bowel to die off. This allows the contents of the gut to leak into the body. That can cause severe stomach pain, vomiting and infection throughout the body called sepsis.
Damage to the intestines can develop in the later part of the illness. These life-threatening complications require immediate medical care.
Other possible complications include:
People can get a vaccination against typhoid fever. This is an option if you live where typhoid fever is common. It is also an option if you plan to travel to a place where the risk is high.
Where typhoid fever is common, access to treated water helps avoid contact with the Salmonella enterica serotype typhi bacteria. Management of human waste also helps people avoid the bacteria. And careful hand-washing for people who prepare and serve food is also important.
Two vaccines are available in the United States for people age 2 and older.
The effectiveness of these vaccines wears off over time. So repeat immunization is needed.
Because the vaccine won't provide complete protection, follow these guidelines when traveling to high-risk areas:
If you're recovering from typhoid fever, these measures can help keep others safe:
Your health care provider may suspect typhoid fever based on your symptoms, and your medical and travel history. The diagnosis is often confirmed by growing the Salmonella enterica serotype typhi in a sample of your body fluid or tissue.
A sample of your blood, stool, urine or bone marrow is used. The sample is placed in an environment where bacteria grow easily. The growth, called a culture, is checked under a microscope for the typhoid bacteria. A bone marrow culture often is the most sensitive test for Salmonella typhi.
A culture test is the most common diagnostic test. But other testing may be used to confirm typhoid fever. One is a test to detect antibodies to typhoid bacteria in your blood. Another test checks for typhoid DNA in your blood.
Antibiotic therapy is the only effective treatment for typhoid fever.
The medicine you get to treat typhoid fever may depend on where you picked up the bacteria. Strains picked up in different places respond better or worse to certain antibiotics. These medicines may be used alone or together. Antibiotics that may be given for typhoid fever are:
Other treatments include:
Call your health care provider if you have symptoms of typhoid fever. This is especially important if you or a close companion recently traveled to a place that has a high risk of typhoid fever. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.
Here's some information to help you get ready and know what to expect from your health care provider.
For typhoid fever, possible questions to ask your provider include:
Don't hesitate to ask any other related questions you have.
Your provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your provider may ask: