S typhi is spread through contaminated food, drink, or water. If you eat or drink something that is contaminated with the bacteria, the bacteria enter your body. They travel into your intestines, and then into your blood. In the blood, they travel to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.
Some people 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. Fewer than 400 cases are reported in the US each year. Most cases in the US are brought in from other countries where typhoid fever is common.
Some people develop a rash called "rose spots," which are small red spots on the abdomen and chest.
Other symptoms that occur include:
- Abdominal tenderness
- Bloody stools
- Agitation, confusion, delirium, seeing or hearing things that are not there (hallucinations)
- Difficulty paying attention (attention deficit)
- Mood swings
- Severe fatigue
- Slow, sluggish, weak feeling
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 may be low)
- Stool culture
Fluids and electrolytes may be given by IV (into a vein) or you may be asked to drink water with electrolyte packets.
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.
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.
Health problems that may develop include:
When to Contact a Medical Professional
Call your health care provider if you have any of the following:
- You know you have been exposed to someone who has typhoid fever
- You have been in an area where there are people who have typhoid fever 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
A vaccine is recommended for travel outside of the US to places where there is typhoid fever. The Centers for Disease Control and Prevention website has information about where typhoid fever is common -- www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever. Ask your provider if you should bring electrolyte packets in case you get sick.
When traveling, drink only boiled or bottled water and eat well-cooked food.
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.
Harris JB, Ryan ET. Enteric fever and other causes of fever and abdominal symptoms. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 102.
Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL. Typhoid fever. Lancet. 2015;385;1136-45. PMID: 25458731 www.ncbi.nlm.nih.gov/pubmed/25458731.