Summary
Definition
History and exam
Key diagnostic factors
- high fever
Other diagnostic factors
- dull frontal headache
- abdominal pain
- anorexia
- apathetic-lethargic state
- constipation
- cough
- diarrhea
- malaise
- nausea
- prostration
- chills
- hepatomegaly
- pneumonia
- relative bradycardia
- rigors
- rose spots
- splenomegaly
Risk factors
- overcrowded living in endemic areas
- poor sanitation/untreated water in endemic areas
- poor personal hygiene in endemic areas
- visiting endemic countries (e.g., Indian subcontinent, Mexico)
- travel to areas with poor sanitation within endemic countries
- ignoring hygiene rules while traveling in endemic countries
- travel to the Indian subcontinent
- longer duration of stay in endemic country
- antacid/proton-pump inhibitor (PPI) treatment
Diagnostic tests
1st tests to order
- CBC
- serum aminotransferases
- blood culture
- stool culture
- urine culture
- bone marrow culture
- drug susceptibility testing
Tests to consider
- rose spot culture
Treatment algorithm
suspected enteric fever
confirmed enteric fever
relapse
chronic carriage
Contributors
Authors
Eli Schwartz, MD, DTMH

Professor
Center for Geographical Medicine and Tropical Diseases
Chaim Sheba Medical Center
Tel HaShomer Hospital
Clinical Professor of Medicine
Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv
Israel
Disclosures
ES is an author of a number of references cited in this topic.
Bradley A. Connor, MD

Clinical Associate Professor
Weill Medical College of Cornell University
New York Center for Travel and Tropical Medicine
New York City
NY
Disclosures
BAC declares that he has no competing interests.
Peer reviewers
Chris Parry, MD
Senior Lecturer (Honorary Consultant)
Division of Medical Microbiology and Genitourinary Medicine
School of Infection and Host Defence
University of Liverpool
Liverpool
UK
Disclosures
CP declares that he has no competing interests.
Paul M. Southern, MD, MSc, DTM&H
Professor
Department of Pathology
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
PMS declares that he has no competing interests.
References
Key articles
World Health Organization. Typhoid vaccines position paper. Mar 2018 [internet publication].Full text
Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004 May;82(5):346-53.Full text Abstract
Schwartz E, Shlim DR, Eaton M, et al. The effect of oral and parenteral typhoid vaccination on the rate of infection with Salmonella typhi and Salmonella paratyphi A among foreigners in Nepal. Arch Intern Med. 1990 Feb;150(2):349-51. Abstract
Ochiai RL, Wang X, von Seidlein L, et al. Salmonella paratyphi A rates, Asia. Emerg Infect Dis. 2005 Nov;11(11):1764-6.Full text Abstract
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - typhoid & paratyphoid fever. May 2023 [internet publication].Full text
Engels EA, Falagas ME, Lau J, et al. Typhoid fever vaccines: a meta-analysis of studies on efficacy and toxicity. BMJ. 1998 Jan 10;316(7125):110-6.Full text Abstract
Jackson BR, Iqbal S, Mahon B; Centers for Disease Control and Prevention (CDC). Updated recommendations for the use of typhoid vaccine - Advisory Committee on Immunization Practices, United States, 2015. MMWR Morb Mortal Wkly Rep. 2015 Mar 27;64(11):305-8.Full text Abstract
Frenck RW Jr, Nakhla I, Sultan Y, et al. Azithromycin versus ceftriaxone for the treatment of uncomplicated typhoid fever in children. Clin Infect Dis. 2000 Nov;31(5):1134-8.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Malaria
- Dengue
- Rickettsial infections
More DifferentialsGuidelines
- Yellow Book 2024: health information for international travel: typhoid and paratyphoid fever
- Diagnosis and management of enteric fever in England
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