Overview
Typhoid fever is an infection of the bloodstream and gut caused by the bacterium Salmonella Typhi. A similar illness from related bacteria is called paratyphoid, and the two together are known as enteric fever.
The bacteria are swallowed in food or water contaminated with sewage, or handled by someone who did not wash their hands after using the toilet, and then spread into the blood. Typhoid is common where safe water and sanitation are not yet reliable.
Symptoms
Symptoms usually begin within about three weeks of the bacteria being swallowed, and sometimes later. Unlike many fevers, typhoid builds gradually rather than starting suddenly:
- Fever that climbs over several days and then stays high
- Headache and marked weakness
- Loss of appetite
- Tummy pain
- Constipation, or loose motions
- A dry cough
- Sometimes a rash of flat rose-coloured spots
A fever that has not started to settle after three days deserves a doctor's opinion, whatever else is going on.
When to see a doctor
See a doctor within a day or two for any fever lasting more than three days, especially with headache, weakness and tummy discomfort.
Causes
Salmonella Typhi lives only in people. It leaves the body in the stools of someone infected and reaches the next person by mouth:
- Drinking water contaminated by sewage, or ice made from it
- Food washed or prepared with contaminated water
- Food handled by someone who did not wash their hands after the toilet
- Raw salads and cut fruit, which are not cooked before eating
Risk factors
- Living in or travelling to a place where safe water and sanitation are limited
- Drinking water of uncertain quality, or using it for ice and washing food
- Food prepared where hand washing facilities are poor
- Living with someone who has typhoid or carries the bacteria
Complications
Without treatment the fever can last for weeks and lead to dangerous, sometimes fatal problems, most seriously in the bowel. The warning signs are sudden severe tummy pain, black stools or blood in the vomit.
Symptoms can come back a week or two after treatment, needing another course. A few people carry the bacteria long after they feel well.
Prevention
- Water that is boiled, properly filtered or sealed in a bottle
- Washing hands with soap after the toilet and before eating or cooking
- Eating food that is freshly cooked and still hot
- Care with raw salads, cut fruit and unpasteurised milk bought outside
- Typhoid vaccination, which a doctor can advise on
- Keeping anyone ill away from cooking for others
Diagnosis
Typhoid is confirmed by testing a blood sample, and stool or urine may be tested too. Wherever possible these samples are taken before start, because the bacteria are harder to grow once treatment has begun.
Growing the bacteria also shows which antibiotics work against that strain, which matters because resistance to older antibiotics is now common. Tests for malaria and dengue often run alongside.
Treatment
Typhoid is treated with a course of , adjusted if laboratory results show the strain resists the first choice. Most people are treated at home and feel better within a few days.
Alongside the antibiotic, what matters is plenty of fluids, light food, rest, and paracetamol for fever and aches. Someone vomiting, very weak, or showing signs of a bowel complication is treated in hospital.
The whole course must be completed even after the fever has gone. Tell the doctor if it has not begun to improve after a few days, or if it comes back later.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Typhoid comes from eating cold food or from the change in weather.”What is true?
Fact
Typhoid is caused by bacteria called Salmonella Typhi, which are swallowed in food or water contaminated by sewage or by hands that were not washed after using the toilet. Weather and cold food do not cause it.
Myth“The fever has gone, so the rest of the antibiotics are not needed.”What is true?
Fact
The fever usually settles well before the bacteria are cleared. Health services advise finishing the whole course even when you feel better, because stopping early lets the illness return and helps the bacteria become resistant to the medicine.
Myth“Typhoid spreads through the air, like a cold.”What is true?
Fact
It does not. The bacteria leave an infected person in their stools and reach the next person through contaminated water, food washed or prepared with that water, or food handled by someone who did not wash their hands. Careful hand washing is the single most useful habit at home.
Myth“Once someone has recovered they are no longer a risk to the family.”What is true?
Fact
People can keep passing the bacteria in their stools for a while after they feel well, and a small number become long-term carriers who can pass it on for months or years without being ill themselves. That is why the doctor may advise a check before someone goes back to cooking or handling food for others.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How soon can I go back to work after typhoid?
That depends on how well you feel and on what your work involves. People who prepare food for others, or who care for patients or young children, are usually asked to wait longer and may need a check to make sure they are no longer passing the bacteria. Your doctor can advise on your situation.
Does the typhoid vaccine mean I can never get typhoid?
No vaccine is a complete guarantee. Vaccination lowers the chance of getting typhoid and is worth having, but careful choices about water, food and hand washing still matter. If you develop a fever after vaccination, get it checked in the usual way.
Is typhoid the same as food poisoning?
They are not the same. Ordinary food poisoning usually causes vomiting and loose motions within hours and settles on its own. Typhoid builds up over days into a steady high fever with weakness and headache, spreads into the blood, and needs antibiotics to clear it.
