Typhoid (enteric) fever

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 14 Sep 2025

Last updated: 29 May 2024

Typhoid (enteric) fever mostly occurs in low-income countries where sanitary conditions remain poor and water supplies are not treated.

Transmission occurs through consumption of contaminated food or water.

In high-income countries, enteric fever is mainly seen among travelers returning from endemic areas.

Prolonged febrile illness with normal white blood cell count in returnees from an endemic area should increase suspicion.

Definitive diagnosis depends on bacterial isolation, usually by blood culture.

Choice of antibiotic treatment depends on antibiotic resistance patterns, travel history, and disease severity.

Several vaccines are available that provide some protection against Salmonella typhi. The newer conjugated vaccines provide higher protection, though not all vaccines are available in all countries. Current vaccines do not provide protection against S paratyphi.

Definición

Typhoid fever is a fecal-oral transmissible disease caused by the bacterium Salmonella enterica, serotype typhi. A similar clinical syndrome, paratyphoid fever, is caused by Salmonella enterica, serotype paratyphi, and the terms enteric fever and typhoid infection are used to describe both diseases. Unless otherwise stated, the information presented here will relate to both diseases.

Anamnesis y examen

Principales factores de diagnóstico

high fever

Todos los datos

Otros factores de diagnóstico

dull frontal headache
abdominal pain
anorexia
apathetic-lethargic state
constipation
cough
diarrhea
malaise
nausea
prostration
chills
hepatomegaly
pneumonia
relative bradycardia
rigors
rose spots
splenomegaly

Todos los datos

Factores de riesgo

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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

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

Todos los datos

Pruebas diagnósticas que deben considerarse

rose spot culture

Todos los datos

Algoritmo de tratamiento

Inicial

suspected enteric fever

Agudo

confirmed enteric fever

En curso

relapse

chronic carriage

Colaboradores

Autores

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

Divulgaciones

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

Divulgaciones

BAC declares that he has no competing interests.

Revisores por pares

Chris Parry, MD

Senior Lecturer (Honorary Consultant)

Division of Medical Microbiology and Genitourinary Medicine

School of Infection and Host Defence

University of Liverpool

Liverpool

Divulgaciones

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

Divulgaciones

PMS declares that he has no competing interests.

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Divulgaciones

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Referencias

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Artículos principales

World Health Organization. Typhoid vaccines position paper. Mar 2018 [internet publication].Texto completo

Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004 May;82(5):346-53.Texto completo Resumen

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. Resumen

Ochiai RL, Wang X, von Seidlein L, et al. Salmonella paratyphi A rates, Asia. Emerg Infect Dis. 2005 Nov;11(11):1764-6.Texto completo Resumen

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].Texto completo

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.Texto completo Resumen

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.Texto completo Resumen

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.Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Malaria
- Dengue
- Rickettsial infections
Más Diferenciales
Guías de práctica clínica
- Yellow Book 2024: health information for international travel: typhoid and paratyphoid fever
- Diagnosis and management of enteric fever in England
Más Guías de práctica clínica
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Typhoid (enteric) fever

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

suspected enteric fever

confirmed enteric fever

relapse

chronic carriage

Colaboradores

Autores

Eli Schwartz, MD, DTMH

Divulgaciones

Bradley A. Connor, MD

Divulgaciones

Revisores por pares

Chris Parry, MD

Divulgaciones

Paul M. Southern, MD, MSc, DTM&H

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice