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Typhoid fever

 

Typhoid fever is a serious and potentially fatal bacterial infection. It can cause symptoms of fever, abdominal pain and constipation. If they are not treated, symptoms can rapidly get worse and lead to serious complications, such as internal bleeding.

Typhoid fever is caused by bacteria called Salmonella typhi (S. typhi). It can be contracted by eating food or drinking water that has been contaminated by the S. typhi bacteria.

How common is it?

Typhoid fever is rare in Ireland due to improvements in sanitation and public health. There were 9 cases of typhoid fever reported in Ireland in 2009.

Typhoid fever is a serious health problem in other parts of the world, especially in areas with poor sanitation and no access to clean water, such as India and most of Africa.

The World Health Organization (WHO) estimates that there are 21 million cases of typhoid fever a year, resulting in 216,500 deaths.

Outlook

The outlook depends on whether the infected person is promptly treated with antibiotics. With antibiotic treatment, the outlook is good and less than 1% of people will die due to infection.

Without antibiotic treatment, the outlook can be poor and 10-20% of people will die due to complications.

A vaccination is available that provides protection against typhoid fever. Because it is rare in Ireland, vaccination against typhoid fever is not routinely given as part of the childhood immunisation schedule.

It is recommended that you are vaccinated if you are travelling to parts of the world where typhoid fever is widespread. See Preventing typhoid fever

Fever
A fever is when you have a high body temperature (over 38°C or 100.4°F).
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.
Disease
A disease is an illness or condition that interferes with normal body functions.
Epidemic
An epidemic is a sudden outbreak of disease that spreads through a population in a short time.
Vaccination

Vaccination (or immunisation) is usually given by an injection. It causes the body's immune system to produce antibodies that will fight off a virus or bacteria.

 

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The incubation period (the time it takes for symptoms to appear after infection) for typhoid fever is seven to 14 days.

If not treated, the symptoms develop over four weeks, with new symptoms appearing each week. With treatment, symptoms should quickly improve.

The symptoms of typhoid fever are listed below, although you will not experience all of them.

The first week

Symptoms of typhoid fever in the first week include:

  • fever, which will gradually rise and then settle at around 39-40°C (103-104°F),
  • abdominal pain,
  • constipation or diarrhoea (adults tend to get constipation and children tend to get diarrhoea),
  • vomiting, usually only in children,
  • dry cough,
  • dull headache in the front of the head,
  • delirium (mental confusion),
  • skin rash made up of pink spots 1-4cm wide (usually the rash is made up of fewer than five spots), and
  • a feeling of being increasingly unwell.

The second week

During the second week, the symptoms listed above will become more severe. You may also experience:

  • swelling of the abdomen, and
  • slowing of the heartbeat.

The third week

Symptoms of typhoid fever during the third week include:

  • loss of appetite,
  • weight loss,
  • physical exhaustion,
  • bouts of foul-smelling, yellow-green, watery diarrhoea,
  • severe swelling of the abdomen,
  • rapid breathing, and
  • a deterioration of your mental state, such as severe confusion, apathy and, in some cases, psychosis (a mental state where a person cannot tell the difference between reality and imagination).

An estimated 10-15% of people with typhoid fever develop potentially life-threatening complications, including:

  • internal bleeding,
  • perforation (rupturing or splitting) of the bowel,
  • inflammation of the heart (myocarditis), and
  • the bacteria can begin releasing toxins (poisons), which can lead to multiple organ failure.

The fourth week

If a person survives until the fourth week, their symptoms will gradually improve, though weight loss and physical exhaustion can continue for several months.

 

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.

 

Disease

A disease is an illness or condition that interferes with normal body functions.

 

Fever

A fever is when you have a high body temperature (over 38°C or 100.4°F).

 

Loss of appetite

Loss of appetite is when you do not feel hungry or want to eat.

 

Constipation

Constipation is when you pass stools less often than usual, or when you have difficulty going to the toilet because your stools are hard and small.

 

Vomit

Vomiting is when you bring up the contents of your stomach through your mouth.

Diarrhoea

Diarrhoea is the passing of frequent watery stools when you go to the toilet.

 

Liver

The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

 

Stools

Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.  

Typhoid fever is caused by S. typhi bacteria. When a person becomes infected, they can pass on the bacteria in their stools (faeces) and, less commonly, in their urine.

An estimated 1-5% of people continue to pass the bacteria in their stools or urine for over a year after their symptoms have passed. These people are known as chronic carriers of typhoid fever.

Typhoid fever is spread by:

  • eating food or drinking liquids that have been handled by a carrier of the S. typhi bacteria who has not washed their hands properly after going to the toilet,
  • using a toilet contaminated with bacteria and then touching your mouth before washing your hands, and
  • drinking water or eating shellfish that have been contaminated by infected stools or urine.

Once you have ingested the bacteria, they move to your bowel where they quickly multiply. They can then spread out of the bowel into the intestines, liver, blood and nearby bone marrow.

It is the spread of bacteria out of the bowel that causes symptoms to get worse during the second and third weeks of infection.

Glossary

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Diarrhoea
Diarrhoea is the passing of frequent watery stools.
Fever
A fever is when you have a high body temperature (above 38°C or 100.4°F).
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Bone marrow
Bone marrow is the soft, spongy tissue in the centre of bones that produces blood cells.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.
Contagious
Contagious is when a disease or infection can be easily passed from one person to another through infection.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Stools
Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.
Epidemic
An epidemic is a sudden outbreak of disease that spreads through a population in a short time.

If you develop symptoms of typhoid fever, tell your GP if you have travelled to parts of the world where typhoid fever is present or if you have been in close contact with someone who has travelled in those areas.

A diagnosis can be confirmed by taking a sample of blood, stools and/or urine. These are checked under a microscope for the presence of S. typhi.

These tests do not always detect the bacteria the first time they are used, so you may need a series of tests.

Taking a sample of bone marrow for testing is more accurate, but obtaining the sample is time consuming and painful, so it tends to be done only if other tests are inconclusive.

If testing shows that you have typhoid fever, it is usually recommended that people you live with are also tested in case the infection has spread to them.

Fever

A fever is when you have a high body temperature (over 38°C or 100.4°F).

Stools

Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.

Treatment at home

If typhoid fever is diagnosed early, you can usually be treated with a course of antibiotic tablets. Most people require a seven to 14-day course of antibiotics.

Your symptoms should improve within two to three days of starting antibiotics, but it is important to finish your course as this will prevent symptoms from coming back.

Drink plenty of fluids, get lots of bed rest and try to eat regular meals to keep your strength up. You may find it easier to eat frequent small meals than three large meals a day.

Treatment at hospital

Hospital treatment is usually recommended if:

  • you experience persistent vomiting,
  • you have severe diarrhoea, or
  • your abdomen is swollen.

You will be given injections of antibiotics (intravenous antibiotics) and you may be attached to an intravenous drip, which will give you fluids and nutrients.

If you develop life-threatening complications (which is extremely rare in people being treated with antibiotics), surgery may be required.

Most people respond well to hospital treatment within three to five days, though it may be several weeks before you are well enough to leave hospital.

Treating chronic carriers

Once your symptoms have passed, it is recommended that you have another stool test to see if there are still S. typhi bacteria in your stools. This would mean that you are a chronic carrier of typhoid fever.

If you are a chronic carrier, you will need a 28-day course of antibiotics to 'flush out' any remaining bacteria.

Until testing shows that you are free from bacteria, do not prepare or handle food, and wash your hands thoroughly after going to the toilet.

 

Fever

A fever is when you have a high body temperature (over 38°C or 100.4°F).


Antibiotics

Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.


Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.


Intravenous

Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.


Inflammation

Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.


Stools

Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.


Disease

A disease is an illness or condition that interferes with normal body functions.

 

Vaccination

Vaccination is recommended if you are travelling to parts of the world where typhoid fever is present, especially if you plan to work or live with local people.

Parts of the world most affected by typhoid fever are:

  • Africa, 
  • South Asia,
  • Southeast Asia,
  • the Middle East, and
  • Central and South America.

It is particularly important to get vaccinated if you are visiting these areas.

Contact your GP surgery to check if they offer the vaccine.Alternatively, you can get a vaccination from a private travel clinic.

Vaccinations do not provide life-long immunity against typhoid fever. Depending on the type of vaccine you receive, you will be protected against typhoid fever for one to three years.

Advice for travellers

Vaccinations do not provide 100% protection against typhoid fever, so it is important to take some basic precautions when travelling in countries where typhoid fever is present.

  • Only drink bottled water from a bottle that was properly sealed.
  • Do not buy ice cream, ice cubes or fruit juices from street vendors.
  • Do not eat raw vegetables, peeled fruit, shellfish or salads.

 

Vaccination

Vaccination (or immunisation) is usually given by an injection. It makes the body's immune system produce antibodies that will fight off a virus or bacteria.


Antibodies

Antibodies (also known as immunoglobulins) are proteins in the blood. They are produced by the immune system to fight bacteria, viruses and disease.


Bacteria

Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.


Immunity

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.