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Typhoid (enteric) fever

Last reviewed: 7 Apr 2025
Last updated: 29 May 2024

Summary

Definition

History and exam

Key diagnostic factors

  • high fever
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum aminotransferases
  • blood culture
  • stool culture
  • urine culture
  • bone marrow culture
  • drug susceptibility testing
Full details

Tests to consider

  • rose spot culture
Full details

Treatment algorithm

INITIAL

suspected enteric fever

ACUTE

confirmed enteric fever

ONGOING

relapse

chronic carriage

Contributors

Authors

Eli Schwartz, MD, DTMH
Eli Schwartz

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
Bradley A. Connor

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
  • Typhoid (enteric) fever images
  • Differentials

    • Malaria
    • Dengue
    • Rickettsial infections
    More Differentials
  • Guidelines

    • Yellow Book 2024: health information for international travel: typhoid and paratyphoid fever
    • Diagnosis and management of enteric fever in England
    More Guidelines
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