Typhoid fever is a life-threatening bacterial infection, commonly spread through contaminated food or water, or through person-to-person contact. This disease is most common in areas with poor sanitation, or where food and water may be dirty.

Typhoid fever is caused by a bacteria called Salmonella typhi, which only lives in humans. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract (bowels/gut). In addition, a small number of people can recover from typhoid fever but continue to carry the bacteria in their bodies; these people are called carriers. Both ill persons and carriers shed the bacteria in their feces. Infection occurs when a person eats or drinks food that has been handled by a person who is actively shedding the bacteria (e.g. food that has been contaminated with the infected person’s feces). They may also get sick if sewage contaminated with the bacteria gets into the water they use for drinking or washing food.

Symptoms range from mild to severe. The typical presentation of the disease varies as the disease progresses:
• During the first week, individuals usually present with a gradually increasing fever, and either constipation or diarrhea.
• By the second week, the fever usually persists. The individual may experience abdominal pain due to loose stools (usually yellow-green in color) or an inability to defecate. Rose-colored spots on the lower chest and abdomen may be seen; serious neurological complications (e.g. delirium, coma) may also arise at this stage.
• Further complications may occur by the third week, especially if the person does not receive treatment. These include bleeding and ulceration of the stomach and bowels, enlargement of the liver and spleen, and kidney damage.

The only way to diagnose typhoid fever is through laboratory detection of the presence of the bacteria, either in the individual’s blood or stools. Typhoid fever is treated with antibiotics, which should be started as soon as possible to prevent complications; the choice of antibiotic depends on the severity of disease, and differs from place to place (i.e. some places may have bacteria that are already resistant to certain antibiotics). Supportive management should include rehydration and correction of electrolyte imbalances, and careful monitoring and management of complications, if present.

Since typhoid fever is usually transmitted via contaminated food or water, the most important preventive measure is proper sanitation, which includes filtering or disinfecting drinking water, cooking food thoroughly, and frequent hand hygiene. Typhoid fever may also be prevented through vaccination. There are two types of typhoid vaccines available right now, one administered via injection and one taken orally. Both offer similar levels of protection but are not entirely protective, so proper sanitation should still be of utmost importance.