Causes

The bacteria that cause typhoid fever -- S. typhi -- spread through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enter your body. They travel into your intestines, and then into your bloodstream, where they can get to your lymph nodes, gallbladder, liver, spleen, and other parts of your 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 other countries where typhoid fever is common.

Symptoms

Early symptoms include fever, general ill-feeling, and abdominal pain. A high (typically over 103 degrees Fahrenheit) fever and severe diarrhea occur as the disease gets worse.

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Other symptoms that occur include:

• Abdominal tenderness
• Agitation
• Bloody stools
• Chills
• Confusion
• Difficulty paying attention (attention deficit)
• Delirium
• Fluctuating mood
• Hallucinations
• Nosebleeds
• Severe fatigue
• Slow, sluggish, lethargic feeling
• Weakness

Exams and Tests

A complete blood count (CBC) will show a high number of white blood cells.

A blood culture during the first week of the fever can show S. typhi bacteria.

Other tests that can help diagnose this condition include:

• ELISA urine test to look for the bacteria that cause Typhoid fever
• Fluorescent antibody study to look for substances that are specific to Typhoid bacteria
• Platelet count (platelet count will be low)
• Stool culture

Treatment

Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets.

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.

Outlook (Prognosis)

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.

Possible Complications

• Intestinal hemorrhage (severe GI bleeding)
• Intestinal perforation
• Kidney failure
• Peritonitis

When to Contact a Medical Professional

Call your health care provider if:

• You have had any known exposure to typhoid fever
• You have been in an endemic area and you develop symptoms of typhoid fever
• You have had typhoid fever and the symptoms return
• You develop severe abdominal pain, decreased urine output, or other new symptoms

Prevention

Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. If you are traveling to an area where there is typhoid fever, ask your health care provider if you should bring electrolyte packets in case you get sick.

Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well-cooked food. Studies of an oral live attenuated typhoid vaccine are now under way and appear promising.

Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

Alternative Names

Enteric fever

References

Giannella Ra. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107.

Lima AAM, Guerrant RL. Inflammatory enteritides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchill Livingstone; 2009:chap 97.

Update Date: 4/9/2012

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, 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.