Typhoid Fever: Symptoms, Tests, Treatment and Vaccine

Typhoid (enteric fever) remains common in India, especially where safe drinking water and sanitation are limited. It is caused by the bacterium Salmonella Typhi; a related bacterium, S. Paratyphi, causes a milder paratyphoid fever.

How typhoid spreads

You catch typhoid by swallowing food or water contaminated with the faeces of an infected person. Risky sources include:

• untreated water and ice
• street food, cut fruit and salads washed in unsafe water
• food handled by someone who hasn't washed their hands well

Some people become long term carriers after recovering, shedding bacteria without feeling ill.

Symptoms

Symptoms usually begin 1 to 3 weeks after exposure and build up gradually:

• fever that rises step by step over several days, often reaching 39 to 40°C
• headache, body ache and marked weakness
• stomach pain, loss of appetite
• constipation or diarrhoea
• dry cough
• in some people, faint rose coloured spots on the chest or belly

Without treatment, complications can develop in the second or third week, including intestinal bleeding or perforation, which are emergencies.

Diagnosis

• Blood culture is the standard test and is most likely to be positive in the first week, ideally before antibiotics are started.
• The Widal test looks for antibodies, but it often gives false positives (from past infection or vaccination) and false negatives early on. A single Widal result shouldn't be used alone to diagnose typhoid.
• Newer rapid antibody tests exist but vary in accuracy.

A CBC may show a low or normal white cell count.

Treatment

Typhoid is treated with antibiotics prescribed by a doctor, chosen based on local resistance patterns: drug resistant typhoid is a growing problem in South Asia. Common choices include azithromycin, cefixime and, in hospital, ceftriaxone.

• Take the full course, even after the fever settles.
• Rest, drink plenty of fluids and eat soft, easily digestible foods.
• Use paracetamol for fever as advised.
• Return to the doctor if fever persists beyond 5 to 7 days of treatment, or if you develop severe belly pain or vomiting.

Never self medicate with leftover antibiotics: it fuels resistance and can mask the illness.

Prevention

Vaccination

The typhoid conjugate vaccine (TCV) can be given from 6 months of age and provides longer lasting protection than older vaccines. The Indian Academy of Pediatrics recommends it for children, and it's useful for adults at risk. Vaccines don't give 100% protection, so food and water safety still matter.

Food and water safety

• Drink boiled, filtered or properly purified water.
• "Boil it, cook it, peel it or forget it" when eating outside.
• Wash hands with soap after using the toilet and before eating or cooking: see our guide to hand hygiene.