Typhoid fever is a life-threatening bacterial infection caused by the bacterium Salmonella enterica serotype Typhi (S. typhi). According to the CDC, typhoid fever affects about 22 million people in the world each year. The incidence of typhoid fever in U.S. citizens and residents is low, with the majority of cases being acquired while traveling internationally.
S. typhi live only in humans, and are carried in the bloodstream and intestinal tracts of people who have typhoid fever. A small number of people recover from typhoid fever but continue to carry the bacteria.
Both the carriers and the people who have active typhoid fever shed S. typhi in their stools. Typhoid fever is spread by consuming food or beverages that have been handled by a person who is shedding S. typhi, or if sewage contaminated with S. typhi bacteria gets into water used for drinking or washing food.
When S. typhi bacteria are consumed, they multiply and spread into the bloodstream. Symptoms may not develop for six to 30 days after initial exposure.
The body reacts with signs and symptoms such as:
A sustained fever as high as 102 to 104 degrees Fahrenheit (39 to 40 degrees Celsius)
Loss of appetite
Sometimes a rash of flat, rose-colored spots
The symptoms of typhoid fever may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
Typhoid fever can be diagnosed using a blood test or stool sample to determine the presence of S. typhi bacteria. However, the accuracy of these tests is variable, particularly during the acute phase of the disease. Subsequently, clinical signs and symptoms, as well as travel history, have to be considered when making the diagnosis.
A vaccination for typhoid fever is available. However, it can lose effectiveness after several years, so a booster vaccination may be necessary.
Other preventive measures for travelers to high-risk areas include the following:
Only use water that has been boiled or chemically disinfected for:
Drinking, or preparing beverages, such as tea or coffee
Washing face and hands (can also use alcohol-based gel to wash hands)
Washing fruits and vegetables
Washing eating utensils and food preparation equipment
Washing the surfaces of tins, cans, and bottles that contain food or beverages
Do not eat food or drink beverages from unknown sources
Do not put ice in drinks
Avoid eating food from street vendors
Any raw food could be contaminated and should be avoided, including:
Fruits and vegetables, particularly those that cannot be peeled
Unpasteurized milk and milk products
Any fish caught in tropical reefs rather than the open ocean
Taking antibiotics is not a preventive for typhoid fever.
See your doctor immediately if you think you have been exposed to typhoid fever. People who do not get treatment may continue to have fever for weeks or months, and may eventually die from complications. Treatment will probably include an antibiotic to treat the disease. Specific treatment for typhoid fever will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
It is important to remember that the danger of typhoid fever does not end when symptoms disappear. You could still be carrying S. typhi and the illness could return, or you could pass the disease to other people. People who have typhoid fever should:
Take any prescribed antibiotics.
Wash their hands after using the bathroom
Have a series of stool cultures (to ensure that the S. typhi bacteria are no longer present)
Typhoid fever is very common in developing countries. Travelers to Asia (except Japan), Africa, and Latin America are especially at risk. The CDC recommends avoiding risky food or drink and considering vaccination one to two weeks before traveling to an area where typhoid fever is common.