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.
When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. 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.
Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they're related, S. typhi and the bacterium responsible for salmonellosis, another serious intestinal infection, aren't the same.
Fecal-oral transmission route
The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up the typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn't washed carefully after using the toilet. You can also become infected by drinking water contaminated with the bacteria.
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 22 million people each year, according to the Centers for Disease Control and Prevention. The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you're at increased risk if you:
- Work in or travel to areas where typhoid fever is endemic
- Work as a clinical microbiologist handling Salmonella typhi bacteria
- Have close contact with someone who is infected or has recently been infected with typhoid fever
- Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
- Drink water contaminated by sewage that contains S. typhi
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, less common complications
Other possible complications include:
- 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
With prompt treatment, nearly all people in industrialized nations recover from typhoid. Without treatment, some people may not survive complications of the disease.
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''re 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 vaccine is 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. Carbonated bottled water is safer than uncarbonated bottled water is. 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.
Prevent infecting others
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.