Typhoid Fever

(Enteric Fever)

by Michelle Badash, MS

---

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

---

Definition

Typhoid fever and paratyphoid fever are serious illnesses caused by Salmonella bacteria. It may be Salmonella typhi or Salmonella paratyphi. It occurs most often in developing countries where sanitation is poor. Typhoid fever can be fatal, especially when not treated.

Causes

Typhoid fever is caused by eating foods or drinking beverages contaminated with the Salmonella bacteria. Contamination can occur from:

• Food or drinks handled by someone who is sick or coming down with typhoid fever
• Food or drinks handled by someone who has no symptoms but carries the bacteria
• Sewage contamination of water or food
• Unpasteurized dairy products
• Poultry products left unrefrigerated

Once bacteria enter the body, they infect the intestine. Bacteria can be carried through the bloodstream to other organs.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

• Drinking contaminated water
• Eating raw shellfish
• Eating fruits and vegetables that are raw or have been washed with contaminated water
• Living in, or recent travel, to a country with poor sanitation

Symptoms

Symptoms may include:

• Fever, often for a prolonged time
• Chills
• Severe headaches
• Constipation or diarrhea
• Abdominal pain
• Fatigue or lethargy
• Loss of appetite
• Rose-colored spots on the body
• Dizziness
• Muscle pains
• Swelling of the neck glands, liver, or spleen

Diagnosis

The doctor will ask about your symptoms and medical history,. A physical exam will be done. Typhoid fever is usually diagnosed with a blood culture.

Treatment

Typhoid fever is treated with antibiotics.

Typhoid fever is very contagious until treated. In a small number of cases, people may become typhoid carriers even after the illness has subsided. People who are chronic carriers can shed contagious Salmonella bacteria in their stool or urine. This condition can be treated with antibiotics or, in unusual cases, surgery.

Prevention

There are two main ways to prevent typhoid fever:

Vaccine-A typhoid vaccine is recommended if you are planning to visit a country where typhoid fever is prevalent. However, the vaccine is not always effective and careful food monitoring is just as important.

Careful food monitoring-When you are in an area where typhoid fever is prevalent, always take the following precautions:

• Drink only bottled water or water that has been boiled for at least one minute. This includes ice.
• Eat foods while they are still hot, and ensure that they are thoroughly cooked.
• Avoid any raw fruits and vegetables that cannot be peeled.
• Avoid raw shellfish.
• Avoid unpasteurized dairy products.

RESOURCES:

Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/

World Health Organization (WHO)
http://www.who.int/

CANADIAN RESOURCES:

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

REFERENCES:

Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet . 2005 Aug 27-Sep 2;366(9487):749-62.

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov.... Accessed November 18, 2009.

---

Last reviewed November 2009 by David L. Horn, MD, FACP
Last Updated: 11/24/09