Typhoid fever is caused by Salmonella typhi bacteria. It remains a serious health threat in the developing world, especially for children. Typhoid fever spreads through contaminated food and water or through close contact with someone who's infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage of them may die of complications. Vaccines against typhoid fever are available, but they're only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.
Although children with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually — often appearing one to three weeks after exposure to the disease.
1st week of illness
Once signs and symptoms do appear, you're likely to experience:
- Fever, that starts low and increases daily, often to as high as 103 or 104 F (39.4 or 40 C)
- Weakness and fatigue
- Dry cough
- Loss of appetite
- Abdominal pain
- Diarrhea or constipation
2nd week of illness
If you don't receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience:
- Continuing high fever
- Either diarrhea or severe constipation
- Considerable weight loss
- Extremely distended abdomen
3rd week of illness
By the third week, you may:
- Become delirious
- Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state Life-threatening complications often develop at this time.
4th week of illness
Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you'll visit, and carry a list of the names, addresses and phone numbers of recommended doctors.
If you develop signs and symptoms after you return home, consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than can a doctor who isn't trained in these areas.
Intestinal bleeding or holes
The most serious complication of typhoid fever — intestinal bleeding or holes (perforations) — may develop in the third week of illness. About 5 percent of people with typhoid fever experience this complication.
Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed by the appearance of blood in your stool.
A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening emergency requires immediate medical care.
Other possible complications include:
Type 2 diabetes can be easy to ignore, especially in the early stages when your child is feeling fine. But type 2 diabetes must be taken seriously. The condition can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. Keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications. The long-term complications of type 2 diabetes develop gradually. But eventually, diabetes complications may be disabling or even life-threatening.
- Inflammation of the heart muscle (myocarditis)
- Inflammation of the lining of the heart and valves (endocarditis)
- Inflammation of the pancreas (pancreatitis)
- Inflammation of the gallbladder (cholecystitis)
- Kidney or bladder infections
- Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
- Psychiatric problems such as delirium, hallucinations and paranoid psychosis
Care and Treatment
In many developing nations, the public health goals that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever. The Centers for Disease Control and Prevention recommends being vaccinated if you are traveling to areas where the risk of getting typhoid fever is high.
Two vaccines are available.
- One is injected in a single dose about two weeks before exposure.
- One is given orally in four capsules, with one capsule to be taken every other day.
Neither of the vaccines are 100 percent effective, and both require repeat immunizations as vaccine effectiveness diminishes over time.
Because the vaccine won't provide complete protection, follow these guidelines when traveling to high-risk areas as well:
- Wash your hands Frequent hand-washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn't available.
- Avoid drinking untreated water Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
- Avoid raw fruits and vegetables Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
- Choose hot foods Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors — it's more likely to be contaminated.
If you're recovering from typhoid, these measures can help keep others safe:
- Wash your hands often This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
- Clean household items daily Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
- Avoid handling food Avoid preparing food for others until your doctor says you're no longer contagious. If you work in the food service industry or a health care facility, you won't be allowed to return to work until tests show that you're no longer shedding typhoid bacteria.
- Keep personal items separate Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.