Typhoid fever

Typhoid fever is a life-threatening infection that affects millions of people each year. A certain strain of salmonella bacteria causes it. Typhoid fever is rare in places where few people carry the bacteria. It’s also rare in places that treat water to kill germs and manage human waste well. That’s why typhoid fever is rare in the United States.

Most people in the U.S. who get typhoid fever get it during travel to other countries. Africa and South Asia have the highest rates of typhoid fever.

Antibiotics can treat typhoid fever, but some antibiotics no longer work against the typhoid fever bacteria. This is called antibiotic resistance. Without treatment, there is a small chance of death from typhoid fever complications. Vaccines that protect against typhoid fever help lower the risk of getting the condition.

Symptoms are likely to start slowly, often showing up 1 to 3 weeks after contact with the bacteria.

Early illness

Early symptoms may include:

• Lasting fever that starts low and rises during the day. Fever can go as high as 104 degrees Fahrenheit (40 degrees Celsius).
• Stomach pain.
• Chills.
• Headache.
• Weakness and tiredness.
• Muscle aches.
• Trouble passing stool, called constipation, or loose stools, called diarrhea.
• Rash.

People also may have a cough and may not want to eat.

Later illness

A few weeks after symptoms start, the illness can cause complications in the intestines. Symptoms may include:

• Stomach pain.
• Swollen belly.

In some people, symptoms may return up to a few weeks after the fever goes away.

See a healthcare professional right away if you think you might have typhoid fever. Before traveling to another country, find out where to call to get a list of healthcare professionals. In some places, that may be the closest embassy or consulate.

A strain of bacteria called Salmonella enterica serotype typhi causes typhoid fever. People who have typhoid fever or the bacteria in their body can shed the bacteria in their stool.

Salmonella enterica serotype typhi can spread in water that isn’t treated to kill germs and in food that isn’t cooked, such as raw fruits without a peel. Drinks that may have the bacteria include water, ice made from water that’s not treated, and milk or juice that isn’t treated to kill germs. Drinks that are treated to kill germs are called pasteurized.

People can swallow the bacteria if it gets into food and water. Not washing the hands well after passing stool also can spread the bacteria.

Typhoid carriers

Even after having antibiotic treatment, people who recover from typhoid fever may have the bacteria in their bodies for more than a year. Called chronic carriers, they no longer have symptoms of the condition. But they can spread it to others.

Chronic carriers may need treatment with antibiotics to prevent the spread of typhoid fever.

Typhoid fever is a serious worldwide threat, especially to children. Africa and South Asia have the highest number of infections as well as regular outbreaks. But typhoid fever happens around the world, often spreading through travelers to and from high-risk areas.

If you live in a country where typhoid fever is rare, your risk of getting it is higher if you:

• Work in or travel to areas where typhoid fever is common.
• Work in a lab that handles Salmonella enterica serotype typhi bacteria or stores samples of the bacteria.
• Have close contact with someone who is infected or recently has been infected with typhoid fever.

Typhoid fever complications may include:

• An infection caused by gut bacteria spreading throughout the body, called sepsis.
• Bleeding in the intestines. This is from holes, also called perforations, in the intestines.
• Changes in thinking, awareness and how you see what’s around you.
• A weakness in an artery caused by an infection, called mycotic aneurysm.

These are life-threatening complications that need medical care right away.

A vaccine can help protect against typhoid fever. You might get the vaccine if you live where typhoid fever is common. Or you might get the vaccine if you plan to travel to a place where the risk is high.

Vaccines

There are two vaccines in the United States. They come in the form of:

• A single shot you get at least one week before travel. People age 2 and older can take this. It lasts two years.
• Four capsules you take by mouth every other day. People age 6 and older can take this form. It lasts up to 5 years.

The vaccine doesn’t completely protect you from typhoid fever. So follow these guidelines when in high-risk areas:

• Wash your hands often and well. Use hot, soapy water. Wash before eating or making food and after using the toilet or changing a diaper. Carry an alcohol-based hand sanitizer for when you don’t have soap and water.
• Don’t use water that isn’t safe. In places where typhoid fever is common, drinking water often has the bacteria that causes it. So drink only bottled water or canned or bottled carbonated drinks, wine or beer. Ask for drinks without ice. Use bottled water to brush your teeth and try not to swallow water in the shower.
• Don’t eat raw fruits and vegetables. Because raw produce may have been washed in tainted water, don’t eat fruits and vegetables that you can’t peel, especially lettuce. To be safe, don’t eat any raw foods.
• Choose hot foods. Don’t eat food that’s stored or served at room temperature. Cooked, steaming hot foods may be less risky than other foods.

Don’t infect others

If you’re recovering from typhoid fever, you can help keep others safe. Besides washing your hands well and often, do the following:

• Take your antibiotics. Do as your healthcare professional tells you when taking your antibiotics. Take all the pills in the prescription.
• Don’t handle food. Don’t make food for others until your healthcare professional says it’s safe. If you’re a food or healthcare worker, you may need to take a test to show that you’ve stopped shedding typhoid bacteria before you return to work.

Your healthcare professional may suspect typhoid fever based on your symptoms and your medical and travel history. Lab tests can confirm the diagnosis.

Tests

A healthcare professional tests a sample of blood, stool or urine for the bacteria. The lab uses the sample to try to grow bacteria. If bacteria grow, the lab checks the growth, called a culture, under a microscope for the typhoid bacteria. Sometimes, a healthcare professional tests a sample of bone marrow.

There are other tests to diagnose typhoid fever. One test detects proteins the body makes to fight off bacteria in the blood. These are called antibodies. Another test looks for typhoid bacteria DNA in the blood.

Antibiotic medicine is the only treatment for typhoid fever. The medicine can help you get better faster and lower the risk of complications. Without treatment, you can have the fever for weeks or months.

Commonly prescribed antibiotics

The medicine you get to treat typhoid fever may depend on how bad the illness is and where you picked up the bacteria. Sometimes one or more antibiotics don’t work on the bacteria. Called antibiotic resistant, these bacteria make treating typhoid fever harder.

Antibiotics that may treat typhoid fever are:

• Fluoroquinolones. These antibiotics, including ciprofloxacin (Cipro), may be a first choice. They stop bacteria from copying themselves.
• Cephalosporins. This group of antibiotics keeps bacteria from building cell walls. One kind, ceftriaxone, is used if there is antibiotic resistance.
• Macrolides. This group of antibiotics keeps bacteria from making proteins. One type, called azithromycin (Zithromax), can be used if there is antibiotic resistance.
• Carbapenems. These antibiotics also prevent bacteria from building cell walls. Antibiotics in this group may treat serious typhoid fever that other antibiotics don’t help.

Other treatments

Other treatments include surgery. If your intestines or blood vessels are damaged, you may need surgery to repair them.

Call your healthcare professional if you have symptoms of typhoid fever. This is very important if you or someone with whom you have close contact recently traveled to a place where the risk of typhoid fever is high. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.

Here’s information to help you get ready for your appointment.

What you can do

When you make an appointment, ask if there’s anything you need to do before your visit. There may be ways you can lower the risk of spreading the bacteria to someone else.

Make a list of:

• Your symptoms and when they began.
• Ways you might have had contact with the bacteria. Note any travel abroad, including the countries you visited and when.
• Key medical information. List other conditions for which you’re being treated and all medicines, vitamins and supplements you take, including doses. Also list vaccines you’ve had.
• Questions to ask your healthcare professional.

For typhoid fever, questions to ask include:

• What might be the cause of my symptoms?
• What tests do I need?
• Are there treatments?
• I have other health conditions. How can I best manage these conditions together?
• How long do you think it will take me to recover fully?
• When can I go back to work or school?
• Am I at risk of any long-term complications from typhoid fever?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Does anything make your symptoms better or worse?
• Did your symptoms get better and then come back?
• Did you update your vaccinations before traveling?