Salmonella enterica serotypes Typhi, Paratyphi A, Paratyphi B, and Paratyphi C cause potentially severe and occasionally life-threatening bacteremic illnesses referred to as typhoid fever (for Typhi serotype) and paratyphoid fever (for Paratyphi serotypes), and collectively as enteric fever. It primarily affects the small intestines and is often associated with poor sanitation and contaminated food or water. Understanding the causes, symptoms, treatment options, and preventive measures is essential for effective management of this disease.

Epidemiology, Risk Factors and Disease Burden

According to the WHO report, as of 2019 estimates, there are 9 million cases of typhoid fever annually, resulting in about 110,000 deaths per year. Typhoid risk is higher in populations that lack access to safe water and adequate sanitation, and children are at highest risk. However, the disease continues to be a public health problem in many developing areas of the WHO African, Eastern Mediterranean, Southeast Asia, and Western Pacific Regions.

Travelers visiting friends and relatives are at increased risk because they might be less careful with food and water while abroad than other travelers and might not seek pretravel health consultation or typhoid vaccination. Although the risk of acquiring illness increases with the duration of stay, travelers have acquired typhoid fever even during visits of <1 week to countries where the disease is highly endemic.

Causes and Transmission

Humans are the only source of the bacteria that cause enteric fever; no animal or environmental reservoirs have been identified. Typhoid and paratyphoid fever are acquired through the consumption of water or food contaminated by feces of an acutely infected or convalescent person, or a person with chronic, asymptomatic carriage. The risk for infection is high in low- and middle-income countries with endemic disease and poor access to safe food or water, and poor sanitation. Sexual contact, particularly among men who have sex with men, has been documented as a rare route of transmission.

Sign & Symptoms

Symptoms of typhoid and paratyphoid fever typically develop gradually over a period of 10 to 14 days following exposure. Common symptoms include:

• High fever (often reaching up to 104°F or 40°C)
• Abdominal pain and discomfort
• Diarrhea or constipation
• Nausea and vomiting
• Headaches and muscle pain
• Loss of appetite

As the infection progresses, patients may experience more severe symptoms such as intestinal perforation, which can lead to serious complications like hemorrhage or sepsis if not treated promptly.

What is the treatment for Typhoid & Paratyphoid fever?

Salmonella infection can be treated with antibiotics. Antibiotic therapy is the mainstay of treatment for enteric fever. Treatment should be started as soon as the diagnosis is suspected, as delays prolong the course of illness and result in a higher risk of complications and severe disease. Outpatient treatment consists of oral antibiotics, antipyretics, and commercially available oral replacement fluids when required for vomiting and diarrhea.  While many cases can be treated at home, hospitalization may be necessary for patients with severe symptoms, such as: persistent vomiting, severe diarrhea, abdominal pain, and signs of dehydration. In a hospital setting, patients may receive intravenous (IV) antibiotics and fluids to manage dehydration and other complications effectively

Even after antibiotic treatment, a small number of people who recover from typhoid fever still have the bacteria living in their bodies. These people are known as chronic carriers. They no longer have symptoms of the disease. But they still shed the bacteria in their stools and spread it.

How can typhoid fever be prevented while traveling?

All travelers to endemic areas are at potential risk of typhoid fever, although the risk is generally low in tourist and business centers where standards of accommodation, sanitation, and food hygiene are high. The following recommendations will help ensure safety while traveling:

• Ensure food is properly cooked and still hot when served.
• Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
• Avoid ice unless it is made from safe water.
• Only drink bottled water from a bottle that was properly sealed, or water that's been recently boiled
• Wash hands thoroughly and frequently using soap. This is the single most important thing you can do to keep from spreading the infection to others. Use hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
• Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
• Typhoid vaccination is recommended for travelers to endemic areas, particularly those traveling to South Asia and those with health or travel-related risks traveling to other endemic areas.  Two typhoid vaccines are licensed for use in the United States: Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for intramuscular use; and live attenuated vaccine (Vivotif, manufactured from the Ty21a strain of serotype Typhi by PaxVax) for oral use.

1. Vi Capsular Polysaccharide Vaccine (ViCPS)
   • Primary vaccination with ViCPS consists of one 0.5-mL (25-μg) dose administered intramuscularly ≥2 weeks before travel.
   • Recommended for: Individuals aged 2 years and older.
   • Administration: A single intramuscular injection.
   • Booster: Recommended every 2 years for those at continued risk.
2. Live Attenuated Ty21A Vaccine
   • Travelers should complete the Ty21a vaccine regimen ≥1 week before potential exposure
   • Recommended for: Individuals aged 6 years and older.
   • Administration: Consists of four capsules taken every other day.
   • Booster: Recommended every 5 years if there is ongoing exposure risk.

Say Goodbye to Typhoid Fever with Our Expert Treatment!

Are you experiencing symptoms of typhoid fever or seeking the best care for a loved one? We’re here to help you recover quickly and safely with our advanced treatment plan, tailored to your needs. Contact the nearest Nusa Medica Clinic to get medical assistance.(*)

Source :
Who. 2023. Typhoid. Available from: https://www.who.int/news-room/fact-sheets/detail/typhoid
Bhandari J, Thada PK, Hashmi MF, et al. Typhoid Fever. [Updated 2024 Apr 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557513/
CDC (Travel-Associated Infections & Diseases). 2024. Typhoid & Paratyphoid Fever.

Available from: https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/typhoid-and-paratyphoid-fever#transmission
Kuehn R, Stoesser N, Eyre D, Darton TC, Basnyat B, Parry CM. Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins. Cochrane Database Syst Rev. 2022 Nov 24;11(11):CD010452. doi: 10.1002/14651858.CD010452.pub2. PMID: 36420914; PMCID: PMC968613

Frequently Asked Questions (FAQs)

1. Can typhoid fever be cured?

Yes, Typhoid fever can be cured if treated with proper and prompt treatment. The prognosis for patients with typhoid fever is very good. Most individuals make a full recovery with no long-term effects. Taking antibiotics completely can avoid complications or relapse of the disease. Here are some notes that are important in curing typhoid fever:

• Early Diagnosis & Treatment: Early diagnosis and prompt treatment are crucial to prevent complications.
• Take your Antibiotic until it is finished:

Antibiotics are the most effective treatment for typhoid fever. Doctors will usually prescribe antibiotics, and some common antibiotic choices are fluoroquinolones (such as ciprofloxacin), cephalosporins (such as ceftriaxone), macrolides (such as azithromycin), and carbapenems.

Make sure to take antibiotics according to your doctor's instructions, even if you are starting to feel better. This is because you can still potentially transmit the disease to others for a long time even though your symptoms have disappeared. In addition, taking antibiotics according to the duration prescribed by your doctor also allows the medicine to work more effectively in treating the infection completely.

• Supportive therapy:
• Hydration:

Typhoid can cause vomiting and diarrhea, and fever can also increase sweat production. Maintaining adequate hydration such as drinking water during typhoid recovery is essential. Water is still the best source of fluid. Besides restoring lost body fluids and preventing dehydration, it will also help avoid the risk of other health problems such as increased stomach acid, and excessive sugar intake. In more severe cases of dehydration, intravenous fluid rehydration is sometimes required.

• Get Enough Rest: Bed rest and do not exert yourself in work or strenuous activities.
• Diet:

A nutritionally balanced diet, soft consistency, sufficient calories and protein, low in fiber that are gentle on the digestive system.

• Monitoring and Follow-Up: Regular monitoring of symptoms and control by the doctor is essential to know the response to the treatment that has been given.
• Prevention: Practicing good hygiene, including washing hands, drinking safe water, and avoiding raw or undercooked foods, is crucial for prevention and can also help prevent the spread of the infection.

However, about 5% of individuals may become chronic carriers of the bacteria, potentially spreading the disease even after recovery. A typhoid carrier is an individual who harbors the Salmonella typhi bacteria without exhibiting symptoms of typhoid fever. These carriers can still shed the bacteria in their stool or urine, posing a risk of transmission to others. These carriers may require additional medical intervention to eliminate the bacteria.

2. What not to eat in typhoid?

Foods that are high in fiber, spicy, and fat should be avoided during the typhoid healing process. So, what are the food restrictions for typhoid pain that must be avoided to recover quickly? Here are the types:

• Raw Food: Avoid eating raw foods such as unpeeled fruits and vegetables (lettuce, salads, broccoli, and raw berries).
• Spicy food: Avoid spicy foods such as chili peppers, hot sauces, jalapenos, peppers, and spices. These foods can irritate the digestive tract
• High-Fiber Foods: Foods with high fiber content are tough to digest and can distress the digestive system such as whole grains (oats, barley), legumes (beans, lentils), nuts, and seeds.
• Fatty Foods: High-fat and spicy junk foods should be avoided as they are not suitable for typhoid recovery such as onion rings, fried chicken, and potato chips
• Certain-Vegetables: Avoid gas-producing vegetables such as cabbage, broccoli, cauliflower, onions, and asparagus. These can increase bloating and discomfort.
• Dried fruit: Dried fruits have high sugar and can be hard for the stomach to digest like raisins or apricots, and raw berries are high in sugar and fiber, making them difficult to digest.
• Caffeinated and Sugary Beverages: Coffee, tea, and sugary sodas can aggravate dehydration and digestive issues.

3. Can typhoid recover itself?

One of the most serious bacterial infections caused by Salmonella Typhi is typhoid fever, which can be transmitted through contaminated water and food. The question of whether typhoid can heal by itself is still something that is doubtful, this is because this infection if left untreated will cause severe complications.

Although in some cases mild typhoid may resolve without medical intervention, this is not recommended. Most typhoid cases require antibiotic treatment to effectively fight the infection. In about 1 in 5 cases, untreated typhoid can be fatal, typhoid can last for several weeks and can lead to health complications such as bowel perforation and sepsis.

4. How can a person catch typhoid fever?

The fecal-oral route is the main route of transmission of typhoid fever. The bacteria that cause it can be transmitted through the feces and urine of an infected person, these bacteria can contaminate food, water, or drinks and for those who consume contaminated items, this can lead to infection. Here is the mode of transmission from Salmonella Bacterial:

• Contaminated Water: The most significant risk factor for infection is drinking or using water contaminated with an infected person's feces. Areas with poor sanitation and inadequate waste management systems are most prone to contamination by this bacterial infection.
• Contaminated Food:  Infection can occur from contaminated food prepared by an infected person. Raw fruits and vegetables, seafood (especially oysters), and dairy products that are not pasteurized first are some of the riskiest foods.
• Poor Hygiene Practices: If an infected person does not wash their hands after using the toilet, they can transmit this bacteria to food or surface objects. Other people can become infected by handling these contaminated objects and then touching their mouths.
• Asymptomatic Carriers: Some people can carry Salmonella typhi without showing any symptoms. By excreting the bacteria in their feces for a long period of time, these infected people can spread the disease even when the person does not appear sick.
• Environmental Contamination: In areas with high population density and poor sanitation standards, sewage contamination of the water supply can sometimes cause widespread epidemics.

Through the several routes of infection transmission described above, the bacteria will begin to infect since the bacteria have been ingested into the human digestive system. Here are some of the process stages where the bacteria infect humans until the onset of typhoid fever symptoms:

• Survival in the Stomach: For Salmonella to reach the intestines, it must survive in the acidic environment of the stomach. In this case, many bacteria are needed for digestion.
• Invasion of Intestinal Cells: Salmonella attacks the epithelial cells of the intestinal lining in a specific way. This involves incorporating proteins into the host cells that make it easier to enter and multiply.
• Dissemination: Salmonella can penetrate immune cells such as macrophages after penetrating intestinal cells. Because of this, Salmonella can evade the immune system and spread throughout the body via the bloodstream, sometimes resulting in more serious illnesses such as typhoid fever.

5. How serious is typhoid fever to humans?

Typhoid fever is a serious illness caused by the bacteria Salmonella enterica serotype Typhi. Typhoid fever can pose significant health risks, especially if left untreated. Here is an overview of how serious and dangerous typhoid fever can be for humans:

Symptoms and Progression

• Initial Symptoms: Symptoms usually begin on day 6 to 30 days after exposure and include prolonged high fever, fatigue, headache, abdominal pain, nausea, and changes in bowel habits (constipation or diarrhea). Some patients also develop a rash with pink spots on their skin.
• Worsening Condition:  Worsening Condition: In the absence of treatment, symptoms may worsen over several weeks. Fever may become very high (up to 104°F or 40°C), and patients may experience fatigue, confusion, and even abdominal pain.

Complications

Typhoid fever can result in severe complications that can significantly even lead to the risk of death. These complications include:

• Intestinal Bleeding: blockages and ulcerations can cause bleeding in the intestines
• Intestinal perforation: Intestinal perforation is the most significant contributing factor to death from typhoid. Intestinal contents flow into the abdominal cavity due to damage to the intestinal wall, a serious illness that can result in peritonitis, a potentially fatal infection.
• Sepsis: When bacteria enter the circulation, they can cause systemic infection and even septic shock.
• Neurological Problems: Due to the noted changes in mental status, severe cases can lead to disorientation or delirium and are commonly referred to as “nervous fever.”

6. Is typhoid fever contagious?

Yes, typhoid fever is contagious. The spread of typhoid fever is very easily transmitted through contaminated food and water due to poor sanitation. To prevent its transmission, it is necessary to understand how it is transmitted. This is helpful for effective preventive measures to control outbreaks and protect public health.(*)

Writer: dr. Rosalia Puspita Jaya - General Practitioner Nusa Medica Clinic Gili Air