Causes, incidence, and risk factors
The bacteria that causes typhoid fever -- S. typhi -- spreads through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enters your body, and goes into your intestines, and then into your bloodstream, where it can travel to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.
A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.
Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from overseas.
Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the belly and chest.
Other symptoms that occur include:
Signs and tests
A complete blood count (CBC) will show a high number of white blood cells.
A blood culture during first week of the fever can show S. typhi bacteria
Other tests that can help diagnose this condition include:
Fluids and electrolytes may be given through a vein (intravenously). Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.
Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.
Symptoms may return if the treatment has not completely cured the infection.
Calling your health care provider
Call your health care provider if you have had any known exposure to typhoid fever or if you have been in an endemic area and symptoms of typhoid fever develop. Also call your health care provider if you have had typhoid fever and relapse occurs or if severe abdominal pain, decreased urine output, or other new symptoms develop.
Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks.
Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well cooked food. Experimentation with an oral live attenuated typhoid vaccine is now underway and appears promising.
Adequate water treatment, waste disposal, and protection of food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.
Bhutta ZA. Typhoid fever. In: Rakel P, Bope ET, eds. Conn’s Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 48.
Kaye KS, Kaye D. Salmonella infections (including typhoid fever). In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 329.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.