Typhoid Fever (Salmonella Typhi)

Medically Reviewed by Zilpah Sheikh, MD on February 29, 2024
11 min read

Typhoid fever (also called enteric fever) is a serious illness caused by infection with the Salmonella enterica serotype Typhi bacteria. A related bacteria called Salmonella serotype Paratyphi causes a similar but milder illness called paratyphoid fever. Both diseases spread through water or food that has been contaminated by the poop or pee of a person who is infected with the germ. You can also get it from uncooked foods, such as raw, unpeeled fruits and unpasteurized milk or juice.

Typhoid fever used to be very common throughout the world, but now it's rare in countries such as the U.S., Canada, Japan, Western Europe, and Australia because human waste disposal is managed and water is treated to kill germs. However, other areas still have high levels of typhoid. It's more common in parts of South and Southeast Asia, Central and South America, Africa, and the Caribbean. It sickens up to 21 million people around the world each year. Children are more likely to get it than adults.

Typhoid fever vs. typhus

These diseases sound similar, and that's because they are. They have similar symptoms, and people used to think they were the same thing. But now that we have modern tools, we know that they're caused by two different types of salmonellabacteria. In the U.S., people most often get typhus from fleas that are infected by biting rats and opossums, whereas typhoid fever mostly spreads through contaminated food.

People who have typhoid fever release the germ in their pee and poop. If they don’t wash their hands well after going to the bathroom, the germ stays on their hands. It then spreads to other things, including water and food. The bacteria can survive for weeks in water or dried sewage. If you drink or eat contaminated water or food, the bacteria will enter your body. This is generally how you get sick. However, you can (rarely) get it from close contact with a sick person or someone who is a carrier.

A carrier is a person who still has the bacteria in their body, even when they don't look or feel sick and they've taken antibiotics. They can still spread the illness, and this can last up to a year or longer after recovery. Even if you're feeling better, you need to be tested for Salmonella Typhi to make sure you can't spread it.

Your doctor may suspect you have typhoid fever based on your symptoms and your medical and travel history. Make sure you tell your doctor if you've traveled recently, or if you think you've been exposed to typhoid fever. To check that you have it, your doctor will do lab tests to look forthe bacteria that causes it in a sample of your body fluid or tissue.

Your doctor may also do other tests to look for complications, such as:

  • X-rays to look for changes in your lungs
  • EKG
  • Ultrasound
  • Liver enzymes and function tests

Test for typhoid fever

The most common test your doctor will do is a tissue culture. To do that, your doctor may take tissue samples, such as your:

  • Blood (most often)
  • Poop
  • Skin, especially if you have rose spots
  • Bone marrow
  • Pee (rarely)

After they take the sample, technicians will put it in a warm place to let the bacteria grow. Then, they’ll look at it through a microscope to see if there’s any salmonella bacteria in it.

Your doctor may also confirm the infection by testing your blood for antibodies against typhoid bacteria (called a Widal test) or DNA from the bacteria in your blood. Antibodies are proteins your immune system makes that attach to foreign invaders like bacteria so they can be killed.

After you come in contact with the germ that causes typhoid fever, it may take a while for you to get sick. Your symptoms usually show up in 1-3 weeks.

At first, you may get:

  • Fever that can be as high as 103-104 F and may rise one night, fall the next morning, and then continue to rise and fall
  • Headaches
  • Chills
  • Weakness and fatigue
  • Muscle aches
  • Sweating
  • Cough
  • Loss of appetite
  • Diarrhea or constipation
  • A rash of flat, warm pink spots, usually on your chest or stomach

A few weeks after your symptoms start, you may also get severe stomach swelling and pain or an infection called sepsis, affecting the entire body.

In serious cases, you may get life-threatening complications, such as:

  • Confusion
  • Inability to pay attention
  • Inability to respond

If you have any of the following symptoms, you should go to the ER right away:

  • High fever
  • Brain symptoms, such as confusion or seizures
  • Coughing up or vomiting blood
  • Serious stomach pain
  • Bloody or tarry (dark, thick, and sticky) poop

Typhoid fever rash

Typhoid fever sometimes causes a rash called "rose spots." About 30% of people who get infected with Salmonella Typhiget rose spots. In people with light skin tones, rose spots usually appear as groups of 5-15 warm pink spots about the size of a grain of rice or slightly smaller. They tend to last about 3-5 days and are usually on your chest or stomach, but they may also appear on your back, arms, and legs.

Antibiotics are the only way of treating typhoid fever. Most people who start antibiotics soon after getting sick start to feel better in a few days, but you will likely need 7-10 days to recover fully.

If you are very ill or have complications such as vomiting, diarrhea, or swelling in your belly or brain, you may get additional treatments, such as steroids. You may also need to go to the hospital, especially if you're dehydrated or need help breathing.

Some people who have serious intestinal complications, such as peritonitis or ileal perforation, may need to have surgery to repair these. Peritonitis is when one of the tissues in your stomach gets infected, usually due to a hole in your stomach or colon. Ileal perforation is when you get a hole in the last part of your small intestine (called the ileum).

People who are carriers may need surgery to remove their gallbladder because the S.Typhi bacteria hide out there, and the organ's removal can cure the infection.

Typhoid fever medication

The S.Typhi bacteria in different areas may have slightly different versions (these are called "strains"). So, the bacteria you're infected with may or may not respond to certain antibiotics. This is why you must tell your doctor where you've been traveling. This information will help your doctor pick the right antibiotic for you. They may also prescribe a combination of antibiotics.

Some of the antibiotics that your doctor may use include:

  • Carbapenems
  • Cephalosporins, such as ceftriaxone, cefotaxime, or cefixime
  • Fluoroquinolones, such as ciprofloxacin, levofloxacin, or ofloxacin (these are the most often used)
  • Macrolides, such as azithromycin

Some bacteria have developed antibiotic resistance, which means that only a few antibiotics work on them. If you get one of these strains, typhoid fever can be very hard to treat and may result in long-term health problems, which can be life-threatening. Your doctor may do extra tests to see which antibiotics will work on your infection.

To help prevent antibiotic resistance, make sure you complete the entire course of antibiotics as directed by your doctor.

Because of the chance of exposure to antibiotic-resistant strains of S.Typhi, make sure you get vaccinated before you travel. Also, practice good hygiene, especially in regions that have high rates of typhoid fever.

Typhoid fever diet

No diet can treat typhoid fever, but you can ease some of your symptoms by choosing easy-to-digest foods that give you a lot of nutrients, including:

  • Cooked vegetables (avoid raw vegetables)
  • Canned or fresh fruit, such as ripe bananas, applesauce, or melon
  • Refined grains, such as white rice, pasta, and white bread (avoid whole grains until you feel better)
  • Proteins such as eggs, chicken, turkey, fish, tofu, or ground meat
  • Low-fat or fat-free milk, yogurt, and cheese

Make sure you drink plenty of water. And avoid spicy foods and those with high fiber and fat content (such as pastries, potato chips, nuts, seeds, and beans). These foods can be hard to digest and worsen some of your symptoms.

Yes, it's generally spread through food or water contaminated with the S.Typhi bacteria. Food and water can get contaminated when someone with typhoid fever touches your food or water without washing their hands. Sometimes, it spreads when water that has poop or pee in it gets into the food you eat or the water you drink or use to rinse food you eat raw. This might happen when there's a natural disaster in your area, such as a flood or earthquake.

You usually don't get it from direct contact with another person (for instance, you can't get it from kissing someone), but you can get it from touching something they've touched (such as a doorknob) after going to the bathroom and not washing their hands.

Typhoid fever prevention

You’re more likely to get typhoid fever in places where it's common, including parts of South and Southeast Asia, Central and South America, Africa, and the Caribbean. If you travel to one of these places, you should take extra precautions to stay safe.

To avoid getting typhoid fever, you should:

  • Wash your hands often with warm soap and water. Do this especially before you make or eat food and after you go to the bathroom. If warm soap and water aren't available, use an alcohol-based hand sanitizer. And don't make food for other people if you're sick because you might accidentally contaminate their food. Even after you feel better, talk to your doctor about whether you could still be contagious. You can get tested to make sure you’re not a carrier of the bacteria.
  • Avoid raw fruits and vegetables. If you do eat them, peel them first or wash them with bottled water. Wash cooking surfaces and utensils, preferably with bottled water, before and after you use them.
  • Eat packaged or fresh, hot food. These are the safest options when you're not sure if your food is contaminated.
  • Drink only bottled or canned liquids. Use bottled water to brush your teeth. Avoid ice cubes because they may have been made with contaminated water. Also, avoid unpasteurized juice and milk.
  • Get vaccinated before you travel. Vaccines are about 50%-80% effective in preventing an S. Typhi infection. Since the vaccine isn't 100% effective, you should still take care to avoid exposure to the bacteria.
  • Plan for medical care before you travel. The CDC has a web page on getting health care while traveling, which includes a list of recommendations for making a plan before you travel and a list of resources for international travelers. For instance, if you are a U.S. citizen, you can call the local consulate or embassy, and they can help you find doctors in your area.

If you start antibiotics soon after you get sick, you can expect to feel better about a week after starting the right one. Signs that you're getting better include:

  • No fever
  • Improved appetite
  • Reduced diarrhea
  • No body pain
  • Improved energy
  • No chest congestion

People who don't get treatment right away may take weeks before they start to feel better. This also puts them at a higher risk of getting complications, which could further extend their recovery time.

Some people get sick again after they recover. This is called a relapse and is usually a milder case than the first time. If it happens, it's usually about a week after you finish your antibiotics, but it can also happen weeks or months later. In this case, call your doctor because you will likely need more antibiotics.

About 5% of people who have recovered from typhoid fever are carriers. This means that even though you look and feel fine, you can still pass the bacteria in your pee in poop. This can last a year or even longer. Your doctor can test to see if you still carry the S.Typhi bacteria. In some places, you may need to have a negative test before you can go back to work or school.

In the later stages, typhoid fever can damage the walls of your intestines. When your intestinal walls are weakened, partially digested food can leak out of your intestine and spread throughout your body. This can lead to a dangerous infection called sepsis. If you’re sick with typhoid fever and have severe stomach pain and nausea, or any signs of sepsis, call 911 or go to the ER right away.

Signs and symptoms of sepsis include:

  • A change in your mental status, such as delirium, hallucinations, or confusion
  • Seizures
  • Feeling dizzy or light-headed
  • Fast, shallow breathing
  • Sweating when you don't know why
  • Shivering

If you don't get treatment for typhoid fever, you can get serious complications, including:

  • Internal bleeding
  • Holes in your intestines
  • Swollen or burst gallbladder
  • Inflammation of your heart (myocarditis) or the lining of your heart and heart valves (endocarditis)
  • Infection in your major blood vessels (mycotic aneurysm)
  • Inflammation of your pancreas (pancreatitis)
  • Inflammation of the membranes and fluid in your brain and spinal cord (meningitis)
  • Inflammation of your bones (osteomyelitis)
  • Pneumonia or bronchitis
  • Kidney or bladder infection
  • Miscarriage in pregnant people

Two vaccines are currently available in the U.S. to prevent typhoid fever:

Oral vaccine. This is available for people who are at least 6 years old. It comes as four pills that you take every other day, and you need to finish it at least 1 week before you travel. You'll need a booster for this every 5 years.

Injectable vaccine. This is available for people who are at least 2 years old. For this vaccine to be effective, you need to get it at least 2 weeks before you travel. You'll need a booster every 2 years.

These vaccines lower your chance of getting sick, but they don’t guarantee that you won’t get it. So, even if you're vaccinated, practice good hygiene by washing your hands often, and use good food safety habits.

Typhoid fever is a serious infection. You get it by eating or drinking something that's contaminated with Salmonella Typhi bacteria. If you think you have typhoid fever, call a doctor right away. Antibiotics are the only treatment for typhoid fever. You need to start treatment as soon as possible after you get sick to prevent potentially life-threatening complications and a long recovery.

Does typhoid fever ever go away?

Most of the time, typhoid fever goes away when you take antibiotics. The earlier you start treatment, the sooner you will get better. However, about 5% of people will still be contagious after they have recovered. These people are called carriers. Some carriers need to have their gallbladder removed to fully get rid of the bacteria.

What is the survival rate of typhoid fever?

Most people (about 70%-88%) recover from typhoid fever. Of course, your chance of a full recovery is better when you get treatment with antibiotics as soon as possible after getting sick. If you wait to get treatment, it can increase your chance of getting life-threatening complications, preventing complete recovery.