Typhoid Fever - Symptoms and Causes

Overview

Typhoid fever, also known as enteric fever, is a bacterial infection caused by Salmonella. This condition is uncommon in regions with modern water treatment facilities and proper waste management systems.

While rare in the United States, typhoid fever remains a significant health concern in parts of Africa and South Asia, posing a particular threat to children in these regions.

Typhoid fever treatment typically involves antibiotics that target the Salmonella bacteria. Most patients experience improvement within one week of starting appropriate medication. Without proper treatment, however, complications can occasionally be fatal.

Several typhoid vaccines are available that provide partial protection against the disease:

Injectable typhoid vaccine
Oral typhoid vaccine capsules

These vaccines offer important protection but cannot prevent all Salmonella infections. They are particularly recommended for:

Travelers to high-risk regions
Healthcare workers in endemic areas
People living in communities experiencing outbreaks

The most effective prevention methods combine vaccination with careful attention to:

Food safety practices
Clean drinking water
Proper handwashing
Avoiding high-risk foods in endemic areas

Signs and Symptoms

Beginning Stage

Typhoid fever usually starts slowly, with symptoms appearing 1 to 3 weeks after bacterial exposure. Early warning signs include:

Low fever that rises throughout the day, sometimes reaching 104°F (40°C)
Chills
Headache
Weakness and tiredness
Muscle pain
Stomach discomfort
Bowel changes (either diarrhea or constipation)
Skin rash

People might also experience coughing, reduced hunger, and increased sweating during this initial phase. These symptoms often develop gradually rather than appearing all at once.

Advanced Stage

As weeks pass, the condition can worsen and affect the intestines more severely. Advanced symptoms include:

Increased abdominal pain
Severely distended (swollen) abdomen
Sepsis – a dangerous condition where the infection spreads throughout the body

In severe cases, patients may develop serious complications such as:

Confusion
Inability to focus on surroundings
Unresponsiveness to external stimuli

Some patients experience symptom recurrence several weeks after their fever has seemingly resolved.

When to seek medical care

If you suspect you might have typhoid fever, get medical help immediately. This is very important.

When traveling abroad and you fall ill, know who to contact for medical assistance. Your embassy or consulate can often provide a list of local healthcare providers.

If symptoms appear after returning home, try to see a doctor who specializes in travel medicine or infectious diseases. These specialists can often diagnose and treat typhoid fever more quickly than general practitioners.

Important contacts:

Local emergency services
Embassy or consulate in foreign countries
Travel medicine specialists upon return

Healthcare professionals with expertise in tropical diseases can provide the most appropriate treatment for this condition.

What Causes Typhoid Fever

Some people who have recovered from typhoid fever still carry the Salmonella typhi bacteria in their bodies. These individuals, called chronic carriers, no longer show any symptoms of the disease.

However, they continue to release the bacteria in their stool, which can spread to others.

The main way typhoid fever spreads is through the fecal-oral route. This happens when someone with the bacteria doesn’t wash their hands properly after using the bathroom. The bacteria then transfers to food, water, or objects that others might touch.

Typhoid fever is caused by a specific strain of bacteria called Salmonella typhi. This is different from other types of Salmonella bacteria that cause different illnesses.

People typically get infected in areas where typhoid outbreaks commonly occur. The bacteria can spread through:

Contaminated water that hasn’t been treated
Ice made from untreated water
Unpasteurized milk or juice
Unwashed raw fruits without peels
Food handled by someone carrying the bacteria

Risk Factors

Typhoid fever remains a global health concern affecting millions yearly. The highest cases appear in Africa and South Asia, though infections occur worldwide, often through travel connections.

You face a higher risk of typhoid fever if:

You travel to regions where typhoid fever is common, particularly when visiting friends or family. Social situations may pressure you to consume higher-risk foods or drinks.
Your job involves handling Salmonella enterica serotype typhi bacteria as a clinical microbiologist.
You have close contact with someone currently infected or recently recovered from typhoid fever.

People from countries with low typhoid rates must be especially careful when traveling to high-risk areas. Even brief visits to regions where typhoid is established can lead to infection if proper precautions aren’t taken.

Health Problems

Typhoid fever can cause serious harm to the intestines. The infection may damage the walls of the small or large intestine, leading to bleeding.

In severe cases, cells in the intestinal walls die, creating holes that allow gut contents to leak into the body. This leakage can result in:

Intense stomach pain
Vomiting
Widespread infection (sepsis)

These intestinal complications typically develop during later stages of the illness and require emergency medical attention.

Typhoid fever can affect other body systems too:

Body System	Possible Complications
Heart	Inflammation of heart muscle (myocarditis) or heart lining (endocarditis)
Blood vessels	Infection of major vessels (mycotic aneurysm)
Lungs	Pneumonia
Digestive	Inflammation of the pancreas (pancreatitis)
Urinary	Kidney or bladder infections
Brain	Meningitis (inflammation of brain and spinal cord membranes)
Mental health	Delirium, hallucinations, paranoid thoughts

Early treatment helps prevent these serious complications.

Ways to Prevent Typhoid Fever

Two vaccines are available in the United States for people who are 2 years old or older. One option is a single shot that must be given at least one week before travel.

The other is taken by mouth as four capsules, with one capsule every other day. The protection from these vaccines doesn’t last forever. You will need to get vaccinated again after some time.

Since vaccines don’t give complete protection, take these steps when going to areas where typhoid fever is common:

Wash your hands often with hot, soapy water before eating or making food and after using the bathroom. Carry alcohol-based hand sanitizer when soap and water aren’t available.
Don’t drink untreated water. Only drink bottled water or canned or bottled drinks like soda, wine, and beer. Carbonated bottled water is safer than still bottled water.
- Ask for drinks without ice. Use bottled water to brush your teeth and try not to swallow shower water.
Be careful with fruits and vegetables. Avoid raw produce that you can’t peel, especially lettuce, as it may have been washed in dirty water. You might want to avoid all raw foods to be safe.
Eat hot foods. Stay away from food served at room temperature. Fresh, steaming hot foods are usually safer than uncooked foods.
Know where to get medical help. Research medical care options before visiting high-risk areas. Keep a list of healthcare providers with their contact information.

Stopping the Spread to Others

If you’re getting better from typhoid fever, follow these steps to protect those around you:

Take all your antibiotics. Follow your doctor’s instructions and finish your entire prescription. Even if you start feeling better, you should continue taking the antibiotics.
Wash your hands thoroughly. This is the most important way to prevent spreading the infection. Use hot, soapy water and scrub for at least 30 seconds. Make sure to wash before meals and after using the toilet.
Don’t prepare food for others. Wait until your doctor says you’re no longer contagious. If you work in food service, you might need to take a test showing you’re not spreading typhoid bacteria. Healthcare workers may also need testing.

People living in areas where typhoid is common can reduce their risk by using treated water and proper waste management systems. Food handlers should practice careful handwashing to prevent spreading the illness.