Typhoid Fever

What Is It?

Typhoid fever is a potentially life-threatening illness caused by the bacteria Salmonella Typhi.

Typhoid fever is found in most parts of the world (except industrialized regions); travelers are especially prone in Asia, Africa, and Latin America. The symptoms of typhoid fever may vary from person to person. A small proportion of people infected do not have symptoms. Some people may only have a fever that comes on gradually but increases over the first week of illness. Others may experience additional flu-like symptoms, including headache, inability to eat, muscle pain, general feeling of discomfort, mild confusion, non-productive cough, diarrhea, constipation, and abdominal pain. A pink-colored rash on the chest, back, and abdomen can also appear during the second week of illness; however, rash is more commonly seen in people with severe disease. Severe typhoid fever is more likely to lead to major complications, including intestinal bleeding and perforation (a hole in the intestinal wall), severe swelling of the brain, seizures, and pneumonia, which can increase the chance of death. Proper antibiotic treatment reduces the chance of death from typhoid fever.

How is it Acquired?

Consuming contaminated food and water increases chance of infection.

Another source of typhoid fever infection includes contaminated water that is used for drinking or washing/preparing food. Typhoid fever is more common in areas of the world where routine handwashing is not practiced and water treatment is not to standard.

Factors that may increase the likelihood of acquiring typhoid fever include:

• Visiting friends or relatives while traveling
• Treating typhoid fever patients (ie, healthcare workers)
• Remaining in typhoid fever-affected areas for long periods of time
• Not following or being unable to follow safe food and water or hygiene practices

Travelers visiting friends and relatives are particularly prone because they tend to stay longer than tourists, eat local food in homes of people who may be chronic carriers of typhoid fever, and may not take the same precautions as other tourists. They are also less likely to see a healthcare provider prior to travel.

Signs and Symptoms

The symptoms of typhoid fever may vary from person to person.

With typhoid fever, some people may only have a fever that comes on gradually but increases over the first week of illness. Others may have additional flu-like symptoms, including:

• Headache
• Inability to eat
• Muscle pain
• General feeling of discomfort
• Mild confusion
• Non-productive cough
• Diarrhea
• Constipation
• Abdominal pain

Some of these symptoms may even appear before the onset of fever. People may also present with a pink-colored rash that appears on the chest, back, and abdomen during the second week of illness; however, rash is more commonly seen in people with severe disease.

People with severe typhoid fever typically have the following symptoms:

• Increasing fevers over the course of the first week
• Abdominal pain or tenderness
• Constipation
• Diarrhea
• Enlarged spleen
• Enlarged liver

Those with severe typhoid fever are more likely to have major complications of the disease, including intestinal bleeding and perforation (a hole in the intestinal wall), severe swelling of the brain, seizures, and pneumonia, which can increase the chance of death.

Without antibiotic treatment, the likelihood of death from typhoid fever increases. Proper antibiotic treatment reduces the chance of death from typhoid fever, although multidrug-resistant S. Typhi can undermine the success of antimicrobial treatment.

Even if the symptoms go away, a small percentage of people remain chronically infected. This means that they could get sick again or pass typhoid fever to other people. If a person’s job involves contact with food or small children, they could be legally barred from working until a healthcare professional gives them a documented clean bill of health.

Precautions to Take

Some typhoid fever precautions include:

• Only drinking and using safe water for all your activities
• Washing hands often with soap and water
• Eating food that is cooked and served hot
• Only eating fruits and vegetables that have been washed in clean water and that you peeled yourself

Ask your healthcare provider if you may benefit from a typhoid fever vaccine.

Check out the Food and Water Safety Guidelines from the Centers for Disease Control and Prevention for more information.