Typhoid Fever Mayo Clinic

Typhoid fever

Definition

By Mayo Clinic staff

Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized
countries. However, it remains a serious health threat in the developing world. Typhoid
fever spreads through contaminated food and water or through close contact with
someone who's infected. Signs and symptoms usually include high fever, headache,
abdominal pain, and either constipation or diarrhea.

When treated with antibiotics, most people with typhoid fever feel better within a few
days, although a small percentage may die of complications.

Vaccines against typhoid fever are available, but they're only partially effective. Vaccines
are usually reserved for those who may be exposed to the disease or are traveling to areas
where typhoid fever is common.

Symptoms

By Mayo Clinic staff

Although children with typhoid fever sometimes become sick suddenly, signs and
symptoms are more likely to develop gradually — often appearing one to three weeks after
exposure to the disease.

First week of illness

Once signs and symptoms do appear, you're likely to experience:

 Fever, often as high as 103 or 104 F (39.4 or 40 C)

 Headache

 Weakness and fatigue

 Sore throat

 Abdominal pain

 Diarrhea or constipation

 Rash

Children are more likely to have diarrhea, whereas adults may become severely
constipated. During the second week, you may develop a rash of small, flat, rose-colored
spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing
in two to five days.

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Second week of illness

If you don't receive treatment for typhoid fever, you may enter a second stage during
which you become very ill and experience:

 Continuing high fever

 Either diarrhea that has the color and consistency of pea soup, or severe constipation

 Considerable weight loss

 Extremely distended abdomen

Third week of illness

By the third week, you may:

 Become delirious

 Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid
state

Life-threatening complications often develop at this time.

Fourth week of illness

Improvement may come slowly during the fourth week. Your fever is likely to decrease
gradually until your temperature returns to normal in another week to 10 days. But signs
and symptoms can return up to two weeks after your fever has subsided.

When to see a doctor

See a doctor immediately if you suspect you have typhoid fever. If you become ill while
traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find
out in advance about medical care in the areas you'll visit, and carry a list of the names,
addresses and phone numbers of recommended doctors.

If you develop signs and symptoms after you return home, consider consulting a doctor
who focuses on international travel medicine or infectious diseases. A specialist may be
able to recognize and treat your illness more quickly than can a doctor who isn't trained in
these areas.

Causes

By Mayo Clinic staff

Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they're
related, this isn't the same as the bacteria responsible for salmonellosis, another serious
intestinal infection.

Fecal-oral route
The bacteria that cause typhoid fever spread through contaminated food or water and
occasionally through direct contact with someone who is infected. In developing nations,
where typhoid is endemic, most cases result from contaminated drinking water and poor

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sanitation. The majority of people in industrialized countries pick up the typhoid bacteria
while traveling and spread it to others through the fecal-oral route.

This means that S. typhi is passed in the feces and sometimes in the urine of infected
people. You can contract the infection if you eat food handled by someone with typhoid
fever who hasn't washed carefully after using the bathroom. You can also become infected
by drinking water contaminated with the bacteria.

Typhoid carriers
Even after treatment with antibiotics, a small number of people who recover from typhoid
fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years.
These people, called chronic carriers, shed the bacteria in their feces and are capable of
infecting others, although they no longer have signs or symptoms of the disease
themselves.

Risk factors

By Mayo Clinic staff

Typhoid fever remains a serious worldwide threat — especially in the developing

world — affecting more than 21 million people each year, according to the Centers
for Disease Control and Prevention. The disease is endemic in India, Southeast Asia,
Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally
have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you're at increased risk if you:

 Work in or travel to areas where typhoid fever is endemic

 Work as a clinical microbiologist handling Salmonella typhi bacteria
 Have close contact with someone who is infected or has recently been infected with
typhoid fever
 Have an immune system weakened by medications such as corticosteroids or
diseases such as HIV/AIDS
 Drink water contaminated by sewage that contains S. typhi

Complications

By Mayo Clinic staff

Intestinal bleeding or perforation
The most serious complication of typhoid fever — intestinal bleeding or perforation — may
develop in the third week of illness. About 5 percent of people with typhoid fever
experience this complication.

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Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed
by the appearance of blood in your stool.

A perforated intestine occurs when your small intestine or large bowel develops a hole,
causing intestinal contents to leak into your abdominal cavity and triggering signs and
symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection
(sepsis). This life-threatening emergency requires immediate medical care.

Other, less common complications

Other possible complications include:

 Inflammation of the heart muscle (myocarditis)

 Pneumonia

 Inflammation of the pancreas (pancreatitis)

 Kidney or bladder infections

 Infections of the spine (osteomyelitis)

 Infection and inflammation of the membranes and fluid surrounding your brain and
spinal cord (meningitis)

 Psychiatric problems such as delirium, hallucinations and paranoid psychosis

With prompt treatment, nearly all people in industrialized nations recover from typhoid.
Without treatment, some people may not survive complications of the disease.

Preparing for your appointment

By Mayo Clinic staff

Call your doctor if you've recently returned from travel abroad and develop mild symptoms
similar to those that occur with typhoid fever. If your symptoms are severe, go to an
emergency room or call 911 or your local emergency number.

Here's some information to help you get ready, and what to expect from your doctor.

Information to gather in advance

 Pre-appointment restrictions. At the time you make your appointment, ask if there
are any restrictions you need to follow in the time leading up to your visit. Your doctor
will not be able to confirm typhoid fever without a blood test, and may recommend
taking steps to reduce the risk of passing a possible contagious illness to others.

 Symptom history. Write down any symptoms you've been experiencing, and for how
long.

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 Recent exposure to possible sources of infection. Be prepared to describe

international trips in detail, including the countries you visited and the dates you
traveled.

 Medical history. Make a list of your key medical information, including other conditions
for which you're being treated and any medications, vitamins or supplements you're
currently taking. Your doctor will also need to know your vaccination history.

 Questions to ask your doctor. Write down your questions in advance so that you can
make the most of your time with your doctor.

For typhoid fever, possible questions to ask your doctor include:

 What are the possible causes for my symptoms?

 What kinds of tests do I need?

 Are treatments available to help me recover?

 How long do you expect a full recovery will take?

 When can I return to work or school?

 Am I at risk of any long-term complications from typhoid fever?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask
questions during your appointment if you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may
reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

 What are your symptoms?

 When did you first begin experiencing symptoms?

 Have your symptoms seemed to be getting better or worse?

 Did your symptoms briefly get better and then come back?

 Have you recently traveled abroad? Where?

 Did you update your vaccinations before traveling?

 Are you being treated for any other medical conditions?

 Are you currently taking any medications?

Tests and diagnosis

 By Mayo Clinic staff

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 Medical and travel history

Your doctor is likely to suspect typhoid fever based on your symptoms and your
medical and travel history. But the diagnosis is usually confirmed by identifying
S. typhi in a culture of your blood or other body fluid or tissue.
 Body fluid or tissue culture
For the culture, a small sample of your blood, stool, urine or bone marrow is
placed on a special medium that encourages the growth of bacteria. In 48 to 72
hours, the culture is checked under a microscope for the presence of typhoid
bacteria. A bone marrow culture often is the most sensitive test for S. typhi.
 Although performing a culture test is the mainstay for diagnosis, in some
instances other testing may be used to confirm a suspected typhoid infection,
such as a test to detect antibodies to typhoid bacteria in your blood or a test that
checks for typhoid DNA in a blood sample.

Treatments and drugs

By Mayo Clinic staff

Antibiotic therapy is the only effective treatment for typhoid fever.

Commonly prescribed antibiotics

In the United States, doctors often prescribe ciprofloxacin for nonpregnant adults.
Ceftriaxone — an injectable antibiotic — is an alternative for women who are pregnant and
for children who may not be candidates for ciprofloxacin. These drugs can cause side
effects, and long-term use can lead to the development of antibiotic-resistant strains of
bacteria.

Problems with antibiotic resistance

In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it,
however, because of side effects, a high relapse rate and widespread bacterial resistance.
In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment
of typhoid, especially in the developing world. In recent years, S. typhi also has proved
resistant to trimethoprim-sulfamethoxazole and ampicillin.

Supportive therapy
Other treatment steps aimed at managing symptoms include:

 Drinking fluids. This helps prevent the dehydration that results from a prolonged fever
and diarrhea. If you're severely dehydrated, you may need to receive fluids through a
vein in your arm (intravenously).

 Eating a healthy diet. Nonbulky, high-calorie meals can help replace the nutrients you
lose when you're sick.

Prevention

By Mayo Clinic staff

In many developing nations, the public health goals that can help prevent and control
typhoid — safe drinking water, improved sanitation and adequate medical care — may be

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difficult to achieve. For that reason, some experts believe that vaccinating high-risk
populations is the best way to control typhoid fever.

Two vaccines are currently in use — one is injected in a single dose, and the other is given
orally over a period of days. Neither vaccine is 100 percent effective, and both require
repeat immunizations as vaccine effectiveness diminishes over time.

If you're traveling to an area where typhoid fever is endemic, consider being vaccinated.
But because the vaccine won't provide complete protection, be sure to follow these
guidelines as well:

 Wash your hands. Frequent hand washing is the best way to control infection. Wash
your hands thoroughly with hot, soapy water, especially before eating or preparing food
and after using the toilet. Carry an alcohol-based hand sanitizer for times when water
isn't available.

 Avoid drinking untreated water. Contaminated drinking water is a particular problem

in areas where typhoid is endemic. For that reason, drink only bottled water or canned
or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than
uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open
them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to
swallow water in the shower.

 Avoid raw fruits and vegetables. Because raw produce may have been washed in
unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be
absolutely safe, you may want to avoid raw foods entirely.

 Choose hot foods. Avoid food that's stored or served at room temperature. Steaming
hot foods are best. And although there's no guarantee that meals served at the finest
restaurants are safe, it's best to avoid food from street vendors — it's more likely to be
contaminated.

To prevent infecting others

If you're recovering from typhoid, these measures can help keep others safe:

 Wash your hands often. This is the single most important thing you can do to keep
from spreading the infection to others. Use plenty of hot, soapy water and scrub
thoroughly for at least 30 seconds, especially before eating and after using the toilet.

 Clean household items daily. Clean toilets, door handles, telephone receivers and
water taps at least once a day with a household cleaner and paper towels or disposable
cloths.

 Avoid handling food. Avoid preparing food for others until your doctor says you're no
longer contagious. If you work in the food service industry or a health care facility, you
won't be allowed to return to work until tests show that you're no longer shedding
typhoid bacteria.

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 Keep personal items separate. Set aside towels, bed linen and utensils for your own
use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked
first in disinfectant.

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