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Enteric fever / typhoid

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WHO typhoid fever fact sheet diagnosis treatment antimicrobial resistance 2025

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typhoid fever treatment

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https://www.cdc.gov/typhoid-fever/php/rep-strain/index.html

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PMID: 40326553

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Enteric fever (typhoid)

Enteric fever is a systemic bacterial infection caused by Salmonella enterica serovar Typhi (typhoid) or Paratyphi A, B, or C (paratyphoid). Humans are the only reservoir. Infection is acquired by ingesting food or water contaminated with feces from an infected person or chronic carrier.

Clinical features

Incubation is usually 7-14 days. Typical features are:
  • Persistent, gradually rising or sustained high fever
  • Headache, marked fatigue, anorexia, malaise
  • Abdominal pain or distension
  • Constipation or diarrhea
  • Dry cough early in illness
  • Relative bradycardia in some patients
  • Hepatosplenomegaly
  • Leukopenia and mild elevation of liver enzymes
  • Faint, transient rose spots over trunk/chest in a minority of patients
Untreated disease can cause intestinal hemorrhage or ileal perforation, typically after the second week, due to necrosis of Peyer patches. Other rare complications include encephalopathy, hepatitis, cholecystitis, myocarditis, meningitis, pneumonia, and relapse.

Diagnosis

  • Take blood cultures before antibiotics whenever possible. They are most useful early in illness.
  • Culture of bone marrow is more sensitive, including after prior antibiotics, but is not routinely required.
  • Stool or urine culture may be positive later but a positive stool culture may also represent carriage.
  • Request antimicrobial susceptibility testing on any isolate.
  • The Widal test is unreliable for confirming acute typhoid and should not be used as the sole basis for treatment.

Treatment

Typhoid needs medical assessment and prescribed antibiotics. The appropriate empirical antibiotic depends on:
  • Local resistance patterns
  • Country/region of travel or exposure
  • Severity of illness
  • Age, pregnancy status, allergies, and culture susceptibility results
Resistance to fluoroquinolones, ceftriaxone, and other common agents is a major issue, including extensively drug-resistant strains. Culture-directed therapy is therefore preferred. Supportive care includes oral or IV fluids, nutrition, and antipyretics. Patients with shock, delirium, persistent vomiting, gastrointestinal bleeding, severe abdominal pain/distension, or suspected perforation need urgent hospital care.

Prevention

  • Safe drinking water, hand hygiene, sanitation, and thoroughly cooked food are the foundation of prevention.
  • Avoid untreated water, raw salads, unpasteurized dairy products, and food from poor-hygiene sources when in endemic areas.
  • Typhoid conjugate vaccine (TCV) is preferred where available, particularly in endemic settings and for relevant travelers. A 2025 Cochrane review found TCV reduced laboratory-confirmed typhoid substantially (Cochrane review, PMID 40326553).
  • Vaccination does not replace food and water precautions.

Seek urgent care now if

High fever occurs with severe abdominal pain, abdominal rigidity, black/bloody stool, vomiting, confusion, fainting, reduced urine output, or inability to drink fluids.
The WHO typhoid overview describes its fecal-oral transmission, common symptoms, and the role of water, sanitation, and vaccination. The CDC resistance update also emphasizes susceptibility-guided antibiotics because some circulating strains are extensively drug-resistant.
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