Typhoid Fever

Enteric fever, also known as Typhoid fever is a bacterial infection of the gut that can severely affect multiple organs and can potentially be life-threatening. The bacteria that cause a Typhoid infection are called Salmonella typhi and Salmonella paratyphi. 1

It's most commonly spread through contaminated food and water. People living in overcrowded areas with poor sanitation are more at risk of infection. 2 Children are thought to be at a higher risk of infection, this may be because their immune system continues to develop.

Typical typhoid fever symptoms are prolonged fever, headache, nausea, abdominal pain, constipation or diarrhoea. A diagnosis of typhoid fever can be confirmed by analysing a sample of blood, urine or stool. 2 3

Treatment involves antibiotics and replacing lost fluids. Frequent hand washing is important, cooking food thoroughly and drinking only bottled water can also help. Vaccination is possible and is recommended to those who are planning to travel to areas where typhoid fever is common. 3

Anybody can get typhoid fever. Children and young adults are at higher risk. Risk factors can include: 3 4

• Not having access to clean water
• Poor sanitation
• Eating undercooked foods
• Traveling to or living in countries with many cases of enteric fever

Among travelers, enteric fever is more common in adults. The infection can spread easily in urban areas with bad sanitation. 4 5

Children under 5 years old can be regarded as having the highest risk as they only present with fever, and diagnosis may be missed unless they present with complications. 4

The most common symptom is a gradual onset of a persistent fever which can rise to 39-40°C. Other common symptoms can include abdominal pain, diarrhea and constipation. Headache and loss of appetite are also possible. Children may be more irritable, cry or wake up at night. 4 5 6

Fever with the travel history should raise the suspicion of enteric fever. The approach to a diagnosis begins with obtaining the patient’s medical history and physical examination.

A series of laboratory tests may then be requested and can include a stool, blood or urine sample. Once samples are collected, they're analysed under a microscope for the Salmonella bacteria. If tests are inconclusive, a blood marrow sample may be needed to diagnose typhoid fever. 7

Once the diagnosis is confirmed, other members of your household may also need to be tested in case they're also infected. 7

Antibiotic treatment should be started as soon as typhoid fever is suspected. After receiving lab results, the treatment may be adjusted. The antibiotic treatment can last 7-14 days. 3 8

Antibiotic treatment can also be accompanied by supportive care, including: 8

• Antipyretics: medication that is used to treat high fever
• Fluid replacement

Typhoid fever is most commonly found in parts of the world where the water and food may be unsafe. These regions can include East and Southeast Asia, Africa, the Caribbean, Central and South America. 9

There are two approaches to protect yourself from typhoid fever, these are: 9

• Get vaccinated: it's recommended that you visit your doctor 2 weeks before traveling to explore options.
• Practice safe drinking habits, wash hands regularly, cook, wash food well and only drink bottled water.

Those who have started antibiotic treatment may continue to have fever for 3-5 days, however, this gradually decreases. If the fever does not go down within 5 days, alternative antibiotic medication can be considered. 10

Most people who get the correct antibiotic treatment recover without complications. If the antibiotic treatment is not finished as recommended by the doctor, the infection may come back and be harder to treat. 10