Typhoid Fever
What is it?
Typhoid fever is an infection named after the
bacterium that causes it, Salmonella typhi. The
primary symptom is a gradually increasing fever,
but typhoid fever can cause serious complications
in some patients.
Who gets it?
Each year, physicians diagnose about 400 cases
of typhoid fever in the United States. Most of
these occur in people who have picked up the
bacteria while traveling in other countries such
as Pakistan, India, Chile, Mexico, and Peru.
Typhoid fever is more common in countries where
sanitation practices are poor.
What causes it?
The S. typhi bacteria are passed from infected
people through their urine and stool. The bacteria
is spread when someone who is carrying the disease
uses the bathroom, doesn’t wash his or her hands
well, then prepares or serves food. It is also
passed along by flies that have landed on infected
feces, then on food that is later eaten. The
spread of bacteria and infection is more likely to
occur in countries where there is open sewage. The
bacteria must enter the body through the mouth to
cause disease. The S. typhi bacteria follow the
digestive tract and enter immune system cells
called mononuclear phagocytes, where they
multiply. After an incubation period of 10 to 14
days, the bacteria overcome the cells and enter
the bloodstream. Then the small and large
intestine become inflamed and symptoms appear.
Sometimes those who have recovered from typhoid
fever continue to be carriers of the bacteria,
although they have no symptoms, and can still pass
the disease on to others. Elderly women with
chronic gallbladder disease also are carriers of
the typhoid bacteria. The S. typhi bacteria
survive in the gallbladder even after treatment
with antibiotics.
What are the symptoms?
Symptoms of typhoid fever include a fever that
rises over a period of days and remains
persistently high, headache, sore throat,
constipation, joint pain, abdominal pain, loss of
appetite, and fatigue. Some patients develop a
pink rash on the chest and abdomen known as rose
spots. Once the bacteria enter the bloodstream,
they are able to invade tissues such as the
gallbladder and the intestinal lymph tissue. These
intestinal tissues develop bleeding sores that can
cause small holes in the intestinal wall. The
holes allow the contents of the intestine to leak
into the abdominal cavity which irritates its
lining and causes a serious condition called
peritonitis. Peritonitis can lead to death. Those
with typhoid fever can also develop complications
such as pneumonia, heart infections, meningitis,
anemia, joint infections, and enlarged liver and
spleen. In severe cases, the spleen may become so
enlarged that it bursts, or the patient can
develop a brain infection that causes stupor,
delirium, and coma. Untreated, typhoid fever runs
a course of anywhere from four to eight weeks, but
can take many months for full recovery. Typhoid
fever is more likely to cause death in the very
young or very old, or those suffering from
malnutrition.
How is it diagnosed?
Typhoid fever is diagnosed by its symptoms and
any recent history of travel to areas where the S.
typhi bacterium is more common. To confirm the
diagnosis, a physician will take blood, stool, and
urine samples for culture (growth) in a
laboratory. A tissue sample may also be taken.
What is the treatment?
Typhoid fever is treated with antibiotics,
usually chloramphenicol or ceftriaxone.
Antibiotics may relieve symptoms within 24 to 48
hours. Those with severe gastrointestinal bleeding
may require intravenous (IV) feedings until they
are able to digest food. People identified as
carriers of S. typhi should be treated for four to
six weeks even if they show no symptoms.
Physicians may advise those with chronic
gallbladder disease to have their gallbladders
removed in order to ensure that all of the
bacteria are cleaned out and they are no longer
carriers of the disease. Most people with typhoid
fever recover completely. There is a vaccine
available to protect against typhoid fever. It is
most commonly administered to those who are at
high risk of contracting the disease such as those
working in certain laboratory settings, traveling
to areas where the disease is common, or those who
have already been exposed to the bacteria. There
is also a typhoid vaccine available for children
ages of two to five.
Self-care tips
If your travels or work put you at risk for
developing typhoid fever, talk to your doctor
about immunization. When traveling to a country
where the disease is common, take the same
precautions you would use to protect against food
poisoning. For example, eat and drink only foods
and beverages that you know are safe. Safe foods
include those that have been cooked thoroughly and
peeled fruit. In general, do not eat anything that
is raw. Avoid foods from street vendors or
restaurants where you can see conditions are
unhygienic. Safe drinks include boiled water, hot
beverages that are made with boiled water,
pasteurized milk and dairy products, canned or
bottled carbonated drinks, beer and wine. Always
make sure the top of a bottle or can is clean and
dry before drinking because the surface can be
contaminated.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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