What to do now

• Seek evaluation today at a clinic or emergency department.
• Ask for blood cultures before antibiotics if possible, plus antimicrobial susceptibility testing if Salmonella Typhi is isolated. Multiple blood cultures may be needed. Blood culture is the main diagnostic test; Widal serology is not recommended because false positives are common. CDC clinical guidance
• Tell the clinician about travel, untreated-water or street-food exposure, sick contacts, prior antibiotic use, and whether anyone else who ate the same food is ill.
• Do not self-start or share antibiotics. Resistance is common and treatment should be selected according to local resistance patterns and culture results. WHO surveillance standard

Go to emergency care now if any of these occur

• Confusion, fainting, severe weakness, inability to keep fluids down, or very little urine
• Severe or worsening abdominal pain or swelling
• Black/bloody stools, vomiting blood, persistent vomiting
• Trouble breathing, rash with severe illness, or signs of shock
• High fever in a young child, pregnancy, older age, or significant immune suppression

Until assessed

• Drink safe fluids or oral rehydration solution in small frequent sips.
• Use acetaminophen/paracetamol for fever if you can take it safely.
• Avoid preparing food for others and wash hands thoroughly after using the toilet.
• Other infections can look very similar, including malaria, dengue, COVID-19, urinary infection, and viral gastroenteritis, so laboratory confirmation matters. Blood culture sensitivity is imperfect, and cultures may be less likely to be positive after antibiotics. CDC Yellow Book

Current approach to suspected typhoid (enteric fever)

1. Obtain microbiology urgently

• Take blood cultures before antibiotics whenever feasible, but do not delay treatment in a critically ill or septic patient.
• Obtain more than one blood culture if initial culture is negative and suspicion remains.
• Request organism identification and antimicrobial susceptibility testing.
• Stool and urine cultures can add information, but are less sensitive early in illness.
• Bone-marrow culture is more sensitive, especially after prior antibiotics, but is invasive and reserved for selected cases.
• Do not rely on Widal testing to diagnose typhoid because of poor specificity and false positives. CDC clinical guidance

2. Assess severity and admit if indicated

3. Current empiric antibiotic principles

4. Supportive and public-health measures

• Oral or IV fluids and electrolyte correction as needed.
• Acetaminophen/paracetamol for fever if appropriate.
• Strict hand hygiene and no food preparation for other people while ill.
• Notify public health authorities according to local rules after confirmed infection. This is mandatory in many jurisdictions.
• Monitor for relapse, which can occur 1-3 weeks after apparent recovery, and for chronic carriage.

Why culture-guided therapy matters