Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized countries. However, it remains a serious health threat in the developing world, especially for children.
Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include a high fever, headache, abdominal pain, and either constipation or diarrhea.
Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications. Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.
Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease.
Once signs and symptoms do appear, you’re likely to experience:
Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
Weakness and fatigue
Loss of appetite and weight loss
Diarrhea or constipation
Extremely swollen abdomen
If you don’t receive treatment, you may:
Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state
In addition, life-threatening complications often develop at this time.
In some people, signs and symptoms may return up to two weeks after the fever has subsided.
When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you are from the United States and become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you’ll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.
If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn’t familiar with these areas.
Typhoid fever is caused by virulent bacteria called Salmonella typhi. Although they’re related, Salmonella typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, aren’t the same.
Fecal-oral transmission route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid fever is established (endemic), most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that Salmonella typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the toilet. You can also become infected by drinking water contaminated with the bacteria.
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 26 million or more people each year. The disease is established (endemic) in India, Southeast Asia, Africa, South America and many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you’re at increased risk if you:
Work in or travel to areas where typhoid fever is established (endemic)
Work as a clinical microbiologist handling Salmonella typhi bacteria
Have close contact with someone who is infected or has recently been infected with typhoid fever
Drink water contaminated by sewage that contains Salmonella typhi
Intestinal bleeding or holes
The most serious complications of typhoid fever — intestinal bleeding or holes (perforations) in the intestine — may develop in the third week of illness. A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care.
Other possible complications include:
Inflammation of the heart muscle (myocarditis)
Inflammation of the lining of the heart and valves (endocarditis)
Inflammation of the pancreas (pancreatitis)
Kidney or bladder infections
Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
Psychiatric problems, such as delirium, hallucinations and paranoid psychosis
With prompt treatment, nearly all people in industrialized nations recover from typhoid fever. Without treatment, some people may not survive complications of the disease.
In many developing nations, the public health goals that can help prevent and control typhoid fever — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
A vaccine is recommended if you live in or you’re traveling to areas where the risk of getting typhoid fever is high.