What Is Typhoid Fever?

Typhoid fever is a contagious bacterial infection that involves the intestine and lymphatic system. Rare in the United States, typhoid fever is common in developing countries, especially in areas with poor sanitation. Symptoms develop gradually over three weeks; fever, chills and headache occur first. Left untreated, typhoid fever may result in life-threatening intestinal perforation and bleeding.

Some people become symptom-free carriers of the disease when the typhoid bacteria lodge in the bile or in gallstones. The bacteria may then periodically migrate to the bowel and be excreted in the feces, thereby contaminating ground water or vegetation fertilized with human waste. Typhoid fever responds well to antibiotics. Severe symptoms are unlikely with early treatment, although about one in five patients relapses.

What Causes Typhoid Fever?

  • Typhoid is caused by Salmonella typhi, a bacterium that invades the wall of the small intestine.
  • Typhoid fever is spread by water and food contaminated with the fecal matter of an infected person.
  • Nearly 5 percent of former patients become chronic carriers—people who carry the bacteria and spread the disease but have no symptoms themselves.
  • Flies may spread the bacteria and cause epidemics; this is more common in areas with poor sanitation.

Symptoms of Typhoid Fever

  • Persistent fever and chills. Fever is higher in the morning.
  • Headache
  • Abdominal pain
  • Gastrointestinal hemorrhage
  • General feeling of poor health
  • Perforation of the intestine
  • Muscle aches
  • Confusion
  • Nausea and vomiting
  • Fluctuating mood
  • Constipation or diarrhea
  • Agitation
  • Loss of appetite and weight
  • Blood in stools
  • Pale, reddish skin rash (“rose spots”) on the shoulders, chest, and back, lasting for three to four days.
  • Slow, sluggish, lethargic feeling
  • Nosebleeds
  • Hallucinations
  • Personality changes and delirium; coma; seizures in children

Typhoid Fever Prevention

  • Wash hands with soap and warm water often, especially after using the toilet or before handling food. (Infected people should use a separate toilet and wash hands or don gloves before handling others’ food.)
  • Get a typhoid vaccine (though it’s only partially effective) before traveling to high-risk areas.
  • Avoid risky drinks and foods.
  • When traveling abroad or in areas with poor sanitation, drink only bottled water or other bottled beverages, and eat only well-cooked foods and fruit you can peel yourself. Do not use ice.

Typhoid Fever Diagnosis

  • Blood (serological) tests
  • Laboratory tests are required for diagnosis.
  • Culture of the bacterium

How to Treat Typhoid Fever

  • Do not take aspirin or other over-the-counter pain relievers for typhoid fever unless prescribed by your doctor. These medications may lower blood pressure; aspirin may also promote gastrointestinal bleeding.
  • The antibiotic chloramphenicol is most often prescribed to treat typhoid fever in developing countries. Other antibiotics, such as ciprofloxacin or trimethoprim-sulfamethoxazole, can also be effective.
  • Intravenous fluids and electrolytes (mineral salts) may be administered to treat dehydration.
  • Antidiarrheal drugs or narcotics may be warranted to relieve diarrhea and cramps.
  • Blood transfusions may be necessary in the event of intestinal bleeding.
  • Dexamethasone, a corticosteroid drug, may be used in severe cases involving the central nervous system to treat delirium, seizures, or shock.
  • Emergency surgery may be necessary to repair intestinal perforation.
  • Several months of antibiotic treatment may eliminate bacteria from chronic carriers; surgical removal of the gallbladder (cholecystectomy) is occasionally necessary.

When to Call a Doctor

  • Call a doctor if you develop persistent fever and chills along with other symptoms of typhoid fever.


Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at HealthCommunities.com

Published: 16 Sep 2011

Last Modified: 22 Jan 2015