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Typhoid fever

Paratyphoid fever

What is Typhoid fever?

Typhoid fever is a contagious bacterial infection of the intestine and lymphatic system. It is caused by the bacterium Salmonella typhi. The infection is spread by water and food contaminated with the excrement of an infected person. Livestock and pets can become infected with the disease and serve as a reservoir for bacterial growth. Humans are subsequently infected by unsanitary handling of the animal's feces or by fecal contamination of water supplies. Flies may spread the disease and cause epidemics in areas with poor sanitation practices. Typhoid is no longer common in the US but remains a problem in developing countries. Nearly five-percent of all former individuals carry and spread the infection while expressing no outward symptoms.

How is it diagnosed?

Symptoms of typhoid fever include persistent chills or fever, especially one that peaks in the early morning and subsides later, headache, nausea and vomiting, abdominal pain, muscle aches, constipation or diarrhea, loss of appetite, nosebleeds, skin rash that lasts for three or four days. The individual's family may also notice signs of delirium or changes in personality.

Physical exam may reveal a pale, reddish skin rash on the shoulders, chest and back. If the infection is relatively advanced, there may be intestinal bleeding as evidenced by blood in stool samples. Abdominal pain may be localized to the region of the lower intestine.

Tests: The preferred method of diagnosis is isolation of S. typhi from a blood culture that is positive in most individuals during the first two weeks of illness. Urine and stool cultures are positive less frequently but should be taken to increase the diagnostic yield.

Blood tests called febrile agglutinins should be done. This includes the Widal test. Serodiagnosis, however, may include both false-positives and false-negatives.

How is Typhoid fever treated?

The bacterial infection can be treated effectively with a number of antibiotics. When diarrhea is present, fluids and electrolytes must be replaced. Anti-diarrheal medicines and narcotics may be used to relieve loss of fluids and cramps. Corticosteroid drugs may be used in severe cases to treat central nervous system symptoms such as seizures, shock or delirium.

If the intestine becomes perforated, emergency surgery will be needed. Chronic carriers are treated with antibiotics for months to eliminate the bacteria.

Treatment of typhoid fever can be complicated by the presence of antibiotic-resistant bacteria. The bacterium may be carried in the biliary tree. Gallbladder surgery may be used if antibiotic treatment is ineffective.



What might complicate it?

If untreated, the infection can develop a carrier state, progress to systemic infection or cause intestinal perforations. When the intestines become perforated, sepsis or peritonitis may occur. Individuals may relapse after treatment.

Predicted outcome

The outcome of treated typhoid fever is very good. Some individuals relapse after the initial infection subsides, but this is not an indication of more serious disease. If left untreated, the disease may become life threatening. The intestines may become perforated or the infection may spread to the central nervous system.


Other water-borne gastrointestinal infections and intestinal ulceration may present with similar symptoms. Isolation of Salmonella will differentiate typhoid from the other infections.

Appropriate specialists

Gastroenterologist, internist, infectious disease specialist, and general surgeon.

Notify your physician if

  • You or a family member has symptoms of typhoid fever.
  • Any of the following occur during treatment:
    • Fever.
    • Sore throat.
    • Severe cough or coughing up blood.
    • Shortness of breath.
    • Severe abdominal pain or swelling.
    • Rectal bleeding.
    • Pain in the calf or leg.
    • Headache, earache or swollen joints.

Last updated 6 April 2018