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Typhoid fever, also known simply as typhoid, is a bacterial illness caused by Salmonella typhi.[1]

Onset of illness

Symptoms typically begin, six to thirty days after exposure to food or water, contaminated with the feces of an infected person.[2]


Early symptoms may vary from mild to severe.[3][4] Usually, there is a gradual onset of a high fever over several days;[3] weakness, abdominal pain, constipation, headaches, and mild vomiting.[4][5]

Other symptoms

Some people will develop a skin rash, with rose colored spots.[4]

Severe cases and carriers

In severe cases there may be confusion.[5] Without treatment, symptoms may last weeks or months.[4]


Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others.[2]


The cause is the bacterium Salmonella Typhi, that grows in the intestines and blood.[4][5]


Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person.

Risk factor

Risk factors include poor sanitation and poor hygiene.[1]

Risk factor 2

Those who travel in the developing world are also at risk.[5]


Because symptoms are similar to those of many other infectious diseases,[5] diagnosis requires either culturing the bacteria, or detecting the bacterium's DNA in the blood, stool, or bone marrow.[4][1][6]

Bone marrow testing

Culturing the bacterium can be difficult, so [7] bone marrow testing is the most accurate.[6]


The chlorination of public drinking water led to the sharp reduction of typhoid in developed nations.[8] In typhoid-endemic countries,

Typhoid vaccines have been shown to prevent 40 to 90% of cases during the first two years,[9] and may have some effect for up to seven years.[1]

Travel to endemic areas

Vaccination is recommended for those at high risk, or people traveling to areas where the disease is common.[2]

Other efforts

Other efforts to prevent the disease include providing clean drinking water, good sanitation, and handwashing.[4][2]

Infected persons quarantine

Until it has been confirmed that an individual's infection is cleared, the individual should not prepare food for others.[4]


The disease is treated with antibiotics such as azithromycin, fluoroquinolones, or third generation cephalosporins.[1]


Resistance to these antibiotics has been developing, which has made treatment more difficult.[1][10]


In 2015, there were 12.5 million new cases worldwide.[11]

Epidemiology - geography

The disease is most common in India.[1]

Epidemiology - demographic

Children are most commonly affected.[1][2]


Rates of disease decreased in the developed world in the 1940s, as a result of improved sanitation, and use of antibiotics to treat the disease.[2]

Risk of death

The risk of death may be as high as 20% without treatment, and 1 to 4% with treatment.[2]


The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mary.

History 2

In 1907, she was the first typhoid carrier identified and traced, while working as a cook in New York. She was associated with 53 cases and three deaths.[12]

History 3

She died of pneumonia after 26 years in quarantine.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Wain, J; Hendriksen, RS; Mikoleit, ML; Keddy, KH; Ochiai, RL (21 March 2015). "Typhoid fever". Lancet. 385 (9973): 1136–45. doi:10.1016/s0140-6736(13)62708-7. PMID 25458731.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 "Typhoid vaccines: WHO position paper" (PDF). Wkly Epidemiol Rec. 83 (6): 49–59. February 8, 2008. PMID 18260212. Archived (PDF) from the original on April 2, 2015.
  3. 3.0 3.1 Anna E. Newton (2014). "3 Infectious Diseases Related To Travel". CDC health information for international travel 2014 : the yellow book. ISBN 9780199948499. Archived from the original on 2015-07-02.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 "Typhoid Fever". May 14, 2013. Archived from the original on 6 June 2016. Retrieved 28 March 2015.
  5. 5.0 5.1 5.2 5.3 5.4 "Typhoid Fever". May 14, 2013. Archived from the original on 2 April 2015. Retrieved 28 March 2015.
  6. 6.0 6.1 Crump, JA; Mintz, ED (15 January 2010). "Global trends in typhoid and paratyphoid Fever". Clin Infect Dis. 50 (2): 241–6. doi:10.1086/649541. PMC 2798017. PMID 20014951.
  7. Alan J. Magill (2013). Hunter's tropical medicine and emerging infectious diseases (9th ed.). London: Saunders/Elsevier. pp. 568–572. ISBN 9781455740437. Archived from the original on 2017-02-28.
  8. Leal, John L. (1909). "The Sterilization Plant of the Jersey City Water Supply Company at Boonton, N.J." Proceedings American Water Works Association. pp. 100–9.
  9. Milligan, R; Paul, M; Richardson, M; Neuberger, A (31 May 2018). "Vaccines for preventing typhoid fever". The Cochrane Database of Systematic Reviews. 5: CD001261. doi:10.1002/14651858.CD001261.pub4. PMID 29851031.
  10. Chatham-Stephens, K; Medalla, F; Hughes, M; Appiah, GD; Aubert, RD; Caidi, H; Angelo, KM; Walker, AT; Hatley, N; Masani, S; Nash, J; Belko, J; Ryan, ET; Mintz, E; Friedman, CR (11 January 2019). "Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan - United States, 2016-2018". MMWR. Morbidity and Mortality Weekly Report. 68 (1): 11–13. doi:10.15585/mmwr.mm6801a3. PMC 6342547. PMID 30629573.
  11. GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  12. "Nova: The Most Dangerous Woman in America". Archived from the original on 2010-04-26.