TYPHOID FEVER 101: CAUSES, SYMPTOMS, TREATMENT, AND PREVENTION

Typhoid fever is a contagious bacterial infection caused by the salmonella enterica typhi bacterium. It is common in parts of the world with limited access to clean water and proper human waste disposal, such as in some South Asian and African countries.

Common symptoms of typhoid fever include headaches, general body aches, constipation or diarrhea, and fever. The only treatment for this illness is antibiotics for typically one or two weeks. Without antibiotics, the disease progresses and may cause life-threatening complications.  

The typhoid-causing bacteria spread through water and food contaminated with the fecal matter of infected patients. Typhoid vaccines, frequent hand washing, and safe drinking and eating habits can protect you against typhoid fever.

Continue reading to learn more about typhoid fever, its causes, symptoms, treatments, and the precautions you can take for prevention.  

What Is Typhoid Fever?

A highly contagious bacterial infection, Typhoid fever, or Enteric fever, can spread throughout the body, affecting several organs. A gram-negative bacterium called salmonella enterica typhi is responsible for causing the disease.    

This illness rarely occurs in areas with good sanitization, access to clean water, and proper human waste disposal.

In developing nations with poor sanitation and little access to clean water, like many countries in Africa and South Asia, typhoid fever is more prevalent.

Around 80% of typhoid fever cases in the US were found in travelers after returning from a typhoid-endemic region, such as the Indian subcontinent.  

What Happens When A Person Has Typhoid Fever?

The salmonella enterica typhi bacteria typically have an incubation period of 7-14 days but can last up to 30 days. During that period, patients will not experience any symptoms.

1-3 weeks after exposure to the bacteria, a person with typhoid fever may slowly develop the following symptoms:

• A persistent high fever
• Chills
• Aches and pains (headaches, stomach aches, muscle aches) 
• Constipation or diarrhea
• Nausea
• Vomiting
• A rash

If the person does not receive treatment, the symptoms will worsen over the following weeks, and the illness may become fatal.

As the disease progresses, typhoid fever can cause intestinal problems that lead to

• Abdominal pain
• A swollen stomach
• Sepsis (a life-threatening and extensive inflammation throughout the body in response to infection)

In very severe cases, typhoid fever may cause confusion, delirium, and apathy (the inability to pay attention or react to the world around them).

How Long Does Typhoid Fever Last?

If the person receives antibiotic treatment for typhoid fever, their symptoms should quickly improve within a few days (typically 3-7 days).

If you do not receive treatment, your symptoms will worsen over the following weeks, and typhoid fever can linger for several weeks or even months before you fully recover. Moreover, your symptoms can return one to three weeks after recovery.

Without antibiotic treatment, this illness may cause life-threatening complications and possibly death. The death rates from typhoid fever in untreated patients range between 12%-30%.

With the introduction of antibiotics, the mortality rate of patients with typhoid has gone down considerably over the years. Currently, the mortality rate of typhoid fever patients after receiving treatment is less than 1%. 

1%-5% of typhoid fever patients become chronic carriers despite effective antibiotic treatment, meaning their stool and urine remain positive for salmonella typhi for over a year after recovery.

How Do You Catch Typhoid Fever?

The salmonella bacteria pass through the intestines and out of the body with the stool and urine. 

If an infected person does not wash their hands carefully after going to the bathroom, they can transfer the bacteria to foods, objects, and other people upon contact.

You can catch typhoid fever from eating food or drinking water contaminated by the stool or urine of people carrying the bacteria.

Salmonella enterica typhi bacteria can spread on uncooked foods and raw fruits without a peel, such as strawberries, grapes, peaches, and apples. You can also pick up the bacteria by drinking contaminated water, consuming ice from untreated water, or drinking unpasteurized milk. 

How Do You Treat Typhoid Fever?

If you develop typhoid fever symptoms while traveling to a foreign country or after returning home, contact a healthcare provider who specializes in infectious diseases or international travel medicine.

Since bacteria cause typhoid fever, antibiotic therapy is the only effective treatment for this illness. Your doctor may prescribe a specific antibiotic depending on where you caught the salmonella bacteria.

Usually, the infection can be treated at home with antibiotic tablets for 7-14 days if typhoid fever is diagnosed early. In severe cases, hospital admission and intravenous (IV) antibiotic therapy may be required.

Antibiotics commonly prescribed for typhoid fever include the following:

• Fluoroquinolone antibiotics: Quinolones, such as Ciprofloxacin and Ofloxacin, are a class of antibiotics that can stop the growth of bacteria. However, some bacterial strains, known as antibiotic-resistant bacteria, can survive the treatment.
• Cephalosporins: Cephalosporin antibiotics, such as Ceftriaxone, can treat a wide range of bacterial infections and can be effective against antibiotic-resistant bacteria.
• Macrolides: Macrolide antibiotics, such as azithromycin (Zithromax), offer another alternative treatment against quinolone-resistant bacteria.   
• Carbapenems: Carbapenems are slightly more expensive antibiotics. They may be prescribed to treat severe typhoid fever cases that do not respond to other antibiotic treatments.  

A combination of Fluoroquinolones, Cephalosporins, and Macrolides may be used in patients who do not respond to standard therapy.  

Additional typhoid fever treatments include fluid therapy since symptoms such as fever and diarrhea can cause dehydration and malnutrition.

Moreover, complications from typhoid fever may cause intestinal perforation, which would require surgery to repair the intestinal damage.

With prompt antibiotic treatment, most patients should feel better within a few days without serious complications.

Can You Prevent Typhoid Fever?

Given below is a guide to safeguard yourself from the disease:

• Get vaccinated: Before traveling to typhoid-endemic areas, such as Eastern and Southern Asia (especially Pakistan, India, and Bangladesh), Africa, the Caribbean, and Central and South America, ask your healthcare provider about typhoid fever vaccination options. Typhoid fever vaccines can protect you against illness and have become increasingly important with the emergence of strains of typhoid bacteria that resist antibiotic treatment. 
• Wash your hands frequently: Washing your hands well with soap and water, especially before eating and after using the toilet, is one of the best ways to prevent the spread of typhoid fever. Contaminated hands can spread typhoid bacteria to food, objects, and other people.
• Do not use untreated water: When you are staying in an area where typhoid fever is common, drink only bottled water and bottled or canned beverages to avoid consuming contaminated water. Ask for your drinks without ice, brush your teeth using bottled water, and try not to swallow the water when showering. Avoid eating flavored ice and popsicles because they may have been prepared with contaminated water. Note that carbonated bottled water is safer than noncarbonated bottled water. If you only have local water available, boil it well before drinking.
• Avoid raw fruits and vegetables and uncooked foods: Avoid eating raw fruits and vegetables that you cannot peel because they can remain contaminated even after washing them. Avoid stored food or food from street vendors unless thoroughly cooked and still steaming hot.  

Because vaccines do not provide 100% protection, practicing these safety measures is essential, even if you are vaccinated against typhoid fever.   

These precautions can help you avoid catching typhoid fever, especially while traveling, among other illnesses, such as cholera, traveler’s diarrhea, and hepatitis A.

If you experience typhoid fever symptoms, contact a healthcare provider as soon as possible. Early diagnosis and treatment will increase your survival chances and reduce the risk of developing complications from the illness.

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Sources:

• Salmonella Typhi - StatPearls - NCBI Bookshelf
• Typhoid fever in the United States, 1999-2006
• Information for Healthcare Professionals | Typhoid Fever | CDC
• Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections 

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