What typhoid fever is
Typhoid fever is a serious intestinal infection caused by the bacterium Salmonella Typhi. It multiplies in the intestines and enters the bloodstream, which is why the illness brings a long high fever and general poisoning. WHO estimates about 9 million cases and about 110,000 deaths a year worldwide; children are affected more often in regions without safe water and sanitation. Typhoid fever has nothing to do with typhus: they are different diseases with different causes.
How typhoid spreads
People are infected through contaminated water and food: the bacteria get there from the stool of a patient or a carrier (someone who had the illness and keeps shedding the bacteria). Risky items include unwashed vegetables and fruit, untreated water and ice, street food, unpasteurized dairy, and seafood. The risk is higher in South Asia, Africa, Central and South America, and Southeast Asia, where sanitation is poor.
Typhoid symptoms
The incubation period ranges from a few days to a month, most often 1 to 2 weeks. The illness builds gradually:
- the temperature climbs day by day and stays high (102 to 104 °F, or 39 to 40 °C) for a week or longer;
- headache, weakness, loss of appetite, and sluggishness;
- stomach pain, constipation, or, less often, diarrhea;
- in some patients a sparse pink rash appears on the stomach and chest;
- a dry cough and an enlarged liver and spleen.
Mild forms resemble an ordinary cold or an intestinal bug, so if you have a long fever after a trip to the tropics, be sure to tell the doctor where you have been. If you have stomach pain, see the page on abdominal pain.
Why typhoid is dangerous
Untreated, the illness drags on for weeks and can bring severe complications, most often in the 2nd to 3rd week: intestinal bleeding, a perforated bowel, peritonitis, and damage to other organs. Some people who recover become carriers and shed bacteria for years, infecting others. With timely antibiotics the outlook is usually good, but the bacterium is increasingly resistant to antibiotics, which complicates treatment. That is why you must not treat it on your own.
Diagnosis and treatment
The diagnosis is confirmed with a blood test (a culture for the bacterium, plus stool and other tests when needed). Typhoid is treated with antibiotics under a doctor's supervision, usually in an infectious disease hospital; the doctor chooses the drug and duration based on the bacterium's susceptibility. It is important to finish the course. Rest, fluids, and a gentle diet are needed. After recovery the doctor may order tests to rule out carriage; until carriage is ruled out, working with food or with children is not advised.
Prevention and the vaccine
The foundation of protection is safe water and food. When traveling, drink bottled or boiled water, skip the ice, wash your hands, eat well-cooked hot food, and wash fruit and vegetables with clean water or peel them. A vaccine exists for travelers: in the BigMed directory it is Typhim Vi (Sanofi), as a single dose. It is given at least 2 weeks before travel, usually to children from 2 years of age and adults; protection is not absolute and lasts a limited time (usually 2 to 3 years), so hygiene matters even if you are vaccinated. WHO also mentions conjugate vaccines that can be used from an earlier age. Typhoid is not part of Georgia's routine national immunization calendar. The calendar order (No. 01-60/n, version of July 13, 2023) recommends the vaccine from age 2 for specific risks: travel to high-risk areas, contact with a carrier, and laboratory work; it is given for a fee. Clinic prices for the vaccine in Georgia are shown below on this page. Other travel and intestinal infections: hepatitis A, food poisoning, and yellow fever.
When to see a doctor
- a temperature above 100.4 °F (38 °C) for more than 3 days, especially after a trip to the tropics or contact with a patient;
- severe stomach pain, black stool or blood in the stool, a swollen belly: go to a hospital right away or call an ambulance (112);
- marked weakness, confusion, or dehydration;
- 4 to 6 weeks before travel to risk countries, to discuss the vaccine.
