Typhoid Fever: Symptoms, Causes, Treatment And What You May Not Know About This Life-threatening Endemic


Typhoid fever is a life-threatening infection caused by the bacterium Salmonella typhi.  It can lead to a high fever, diarrhea, and vomiting. Typhoid fever is rare in developed countries. It is still a serious health threat in the developing world, especially for children.  It is usually spread through contaminated food or drinking water and it is more prevalent in places where hand washing is less frequent. . The moment Salmonella typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The bacterium lives in the intestines and bloodstream of humans. It spreads between individuals by direct contact with the feces of an infected person. Most people who have typhoid fever feel better a few days after they start antibiotic treatment, but a small number of them may die of complications.  No animals carry this disease, so transmission is always human to human.



People usually have a sustained fever (one that doesn’t come and go) that can be as high as 103–104°F (39–40°C). Other symptoms of typhoid fever and paratyphoid fever include

  • Weakness
  • Stomach pain
  • Headache
  • Diarrhea or constipation
  • Cough
  • Loss of appetite

Some patients may have a rash. Severe cases may lead to serious complications or even death.

Another infection, paratyphoid, is caused by Salmonella enterica. It has similar symptoms to typhoid, but it is less likely to be fatal.


Epidemiology and Risk Factors

WHO estimates the global typhoid fever disease burden at 11-20 million cases annually, resulting in about 128 000–161 000 deaths per year.

Globally, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

Salmonella typhi is passed in the feces and sometimes in the urine of infected people. If you eat food that has been handled by someone who has typhoid fever and who hasn’t washed carefully after using the toilet, you can become infected.

In developing countries, where typhoid fever is established, most people become infected by drinking contaminated water. The bacteria may also spread through contaminated food and through direct contact with someone who is infected.

Improved living conditions and the introduction of antibiotics resulted in a drastic reduction of typhoid fever morbidity and mortality in industrialized countries. In developing areas of Africa, the Americas, South-East Asia and the Western Pacific regions, however, the disease continues to be a public health problem.

Typhoid risk is higher in populations that lack access to safe water and adequate sanitation.


In addition, people who work in or travel to areas where typhoid fever is established as well as people who work as a clinical microbiologists handling Salmonella typhi bacteria are at increased risk.



Intestinal bleeding or holes in the intestine are the most serious complications of typhoid fever. They usually develop in the third week of illness. In this condition, the small intestine or large bowel develops a hole. Contents from the intestine leak into the stomach and can cause severe stomach pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care. Other complications include; Inflammation of the heart muscle, kidney or bladder Infection, pneumonia, hallucinations and paranoid psychosis.



The only effective treatment for typhoid is antibiotics. The most commonly used are ciprofloxacin (for non-pregnant adults) and ceftriaxone. In more severe cases, where the bowel has become perforated, surgery may be required.

It is important to note that even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they can spread it to others through their faeces.

People being treated for typhoid fever to do the following:

  • Take prescribed antibiotics for as long as the doctor has prescribed.
  • Wash their hands with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance of passing the infection on to someone else.
  • Have their doctor test to ensure that no Salmonella typhi bacteria remain in their body.


Vaccination/ Prevention

getting vaccinated against typhoid fever before traveling to a high- risk area is important.  Two vaccines are available.

  • One is given as a single shot at least one week before travel for people aged over 2 years
  • One is given orally in four capsules, with one capsule to be taken every other day for people aged over 5 years.

Please note that both vaccines are not 100% effective therefore there should be repeated immunization since their effectiveness wears off over time.

The following guidelines will help ensure safety while travelling:

  • Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet.
  • Ensure food is properly cooked and still hot when served.
  • Wash fruits and vegetables, peel fruit yourself, and do not eat the peel.
  • Be wary of eating anything that has been handled by someone else.
  • Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
  • When the safety of drinking water is questionable, boil it or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent (usually available at pharmacies).


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