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Typhoid Fever

Typhoid fever, which is caused by the bacterium Salmonella typhi, is common in the developing world; however, only a few hundred cases occur annually in the United States. The life-threatening disease is spread when people accidentally consume the bacteria. When treatment is started early, the prognosis is good; however, 3 to 5 percent of people will continue to carry typhoid fever even after symptoms disappear.

What Is Typhoid Fever?

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. In the United States, about 400 cases occur each year, and 75 percent of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million people each year.
 

What Causes It?

The cause of typhoid fever is an infection with the bacteria known as Salmonella typhi.
 

How Is Typhoid Fever Transmitted?

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding the Salmonella typhi bacteria or if sewage contaminated with the bacteria gets into the water you use for drinking or washing food.
 

Where Is It Common?

Typhoid fever is common in most parts of the world, except in industrialized regions, such as the United States, Canada, Western Europe, Australia, and Japan. Risk is greatest within the Indian subcontinent and other developing countries in Asia, Africa, the Caribbean, and Central and South America.
 

Symptoms of Typhoid Fever

When a person becomes infected with the bacteria that cause typhoid fever, the bacteria begin to multiply and spread into the bloodstream. After 3 to 60 days, symptoms can occur. This period between becoming infected and the start of symptoms is called the incubation period.
 
Symptoms of typhoid fever vary among individuals. Some will have mild symptoms, while others could have very serious symptoms, including death.
 
Common symptoms include:
 
  • Fever as high as 103° to 104° F (39° to 40° C).
  • Stomach pains
  • Headache
  • Weakness
  • Bloody nose
  • Loss of appetite
  • Constipation
  • Decreased heart rate
  • Rash of flat, rose-colored spots.
 

How Is Typhoid Fever Diagnosed?

In order to make a typhoid fever diagnosis, your doctor will:
 
  • Ask a number of questions, including about your recent medical and travel history
  • Perform a physical exam
  • Recommend certain tests.
 
As part of the diagnostic process, your healthcare provider will rule out conditions with similar symptoms, such as:
 
 

What Are the Treatment Options?

Typhoid fever treatment involves antibiotics that can kill the bacteria. Treatment is focused on providing relief of symptoms as the body and antibiotics fight the illness.
 
When appropriate treatment is started early, the prognosis is good. With proper treatment, the mortality rate is generally under 1 percent, and few complications should occur.
 

What Are Typhoid Fever Carriers?

Approximately 3 to 5 percent of people may still carry the typhoid fever bacteria, even if symptoms go away with treatment. These people are known as typhoid fever carriers. The most famous carrier was Mary Mallon, better known as Typhoid Mary. In carriers, it is possible for the illness to return or be passed on to other people.
 

Is There a Vaccine for Typhoid Fever?

One way to prevent typhoid fever is with the typhoid vaccine. There are two types of vaccines. One vaccine contains killed Salmonella typhi bacteria. This vaccine is administered by an injection (shot). The other vaccine contains a live but weakened strain of the Salmonella bacteria. This vaccine is taken by mouth.
 
It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the typhoid vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including:
 
Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD
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