How to diagnose typhoid fever


What is typhoid fever?

Typhoid fever is a bacterial infection that can be life-threatening. Most cases of typhoid fever occur in developing nations. However, the disease can occur anywhere, including industrialized countries like the U.S.

Who is most at risk for getting typhoid fever?

Individuals are most at risk for the disease in developing nations where good sanitation is lacking and people have limited access to clean water and safe foods. These areas are primarily in parts of Asia, Central and South America, Africa, and the Caribbean. Typhoid fever is less common in industrialized nations like the U.S. Most cases of typhoid fever in developed countries occur in returning travelers who can spread the illness to others or in contaminated foods. It is estimated that approximately 5,700 cases occur each year in the U.S. (but only 400 are confirmed).

Symptoms and Causes

What causes typhoid fever?

The bacterium Salmonella typhi (S. typhi) causes typhoid fever. The bacteria spreads through contaminated food, drink, or water. People infected with Salmonella typhi carry the bacteria in their intestinal tract and blood.

Salmonella typhi is shed (discarded from the body) in feces (stool). You may get typhoid fever if you ingest food or beverages prepared by someone who is shedding the bacteria and who does not wash their hands properly. In less developed countries, sewage containing Salmonella typhi may contaminate local water supplies.

In some cases, people who have previously had typhoid fever still carry Salmonella typhi bacteria. These people are carriers of the disease. They may spread the infection even when they have no symptoms (the famous case of “Typhoid Mary” in the U.S.).

What are the symptoms of typhoid fever?

In early stages of the disease, symptoms include: abdominal pain, fever, and a general feeling of being unwell. These initial symptoms are similar to other illnesses.

As typhoid fever gets worse, symptoms often include:

  • High fever of up to 104 degrees Fahrenheit
  • Headaches
  • Abdominal pain, constipation then perhaps diarrhea later
  • Small, red spots on your abdomen or chest (rose-colored spots)
  • Loss of appetite and weakness

Other symptoms of typhoid fever include:

  • Body aches
  • Bloody stools
  • Chills
  • Severe fatigue
  • Difficulty paying attention
  • Agitation, confusion, and hallucinations (seeing or hearing things that are not real)

Diagnosis and Tests

How is typhoid fever diagnosed?

Doctors use a simple blood or stool test to diagnose typhoid fever. This test identifies the presence of Salmonella typhi in blood or stool samples.

In the U.S., doctors may not consider typhoid fever at first because it is uncommon. It’s important to tell your doctor if you have traveled to an area where typhoid fever could be present or if you think you’ve been exposed to someone who could have the infection.

Management and Treatment

How is typhoid fever treated?

Antibiotics are used to treat typhoid fever. These medications kill the bacteria that cause the infection. Several different types of antibiotics are used to treat typhoid fever. In many cases, typhoid fever is treated with ampicillin, chloramphenicol, or cotrimoxazole (Bactrim®). However, doctors also use fluoroquinolones (including Cipro® and Levaquin®), cephalosporins (including Cefepime®), and azithromycin.

Your doctor will choose based on the most up-to-date recommendations. Antibiotics are widely available in the United States and in most other countries in the world. Do not attempt to self-treat with leftover antibiotics.

Some people need supportive therapies, such as fluid or electrolyte replacement, depending on the severity of the infection.

What complications are associated with typhoid fever?

People who do not receive treatment for typhoid fever may have symptoms of the disease for months. In those cases, complications, like kidney failure or intestinal hemorrhage (severe bleeding), are possible. In severe cases, typhoid fever is fatal if left untreated. They may also become carriers and spread the illness to others.


Can typhoid fever be prevented?

If you are traveling outside the U.S., you can lower your risk of contracting the disease by:

  • Receiving a typhoid fever vaccination. Currently, two vaccines are available to help prevent the spread of typhoid fever. Talk with your doctor about getting vaccinated.
  • Avoiding food that is raw or undercooked
  • Drinking only bottled water or water that has been boiled
  • Thoroughly washing your hands each time before eating
  • Avoiding raw fruits and vegetables that cannot be peeled.
  • Avoiding eating foods and beverages purchased from street vendors.

Outlook / Prognosis

What is the prognosis (outlook) for people with typhoid fever?

For most people who receive treatment with antibiotics, typhoid fever symptoms improve within 2 to 4 weeks. Your symptoms may return if you do not finish your entire treatment that your doctor recommends.

Living With

When should I call my doctor?

If you develop any of the symptoms of typhoid fever or your condition does not improve, contact your doctor immediately. He or she can evaluate you to determine if you are infected. If you are traveling outside the U.S. and develop any of the symptoms of typhoid fever, contact that country’s U.S. consulate for a list of recommended doctors.

Last reviewed by a Cleveland Clinic medical professional on 03/01/2018.


  • Centers for Disease Control and Prevention. Typhoid Fever. ( Accessed 3/19/18.
  • World Health Organization. Typhoid. ( Accessed 3/19/18.
  • National Organization for Rare Disorders. Typhoid. ( Accessed 3/19/18.

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What are the signs and symptoms of typhoid fever and paratyphoid fever?

Typhoid fever and paratyphoid fever have similar symptoms̵. People usually have a sustained fever (one that doesn’t come and go) that can be as high as 103–104°F (39–40°C).

How to diagnose typhoid fever

Other symptoms of typhoid fever and paratyphoid fever include

  • Weakness
  • Stomach pain
  • Headache
  • Diarrhea or constipation
  • Cough
  • Loss of appetite

Some people with typhoid fever or paratyphoid fever develop a rash of flat, rose-colored spots.

What do you do if you think you have typhoid fever or paratyphoid fever?

The only way to know for sure if an illness is typhoid fever or paratyphoid fever is to have a sample of blood or stool (poop) tested for Salmonella Typhi or Salmonella Paratyphi.

If you have a fever and feel very ill, see a doctor immediately. If you are traveling outside the United States, you usually can call the U.S. consulate external icon for a list of recommended doctors. For more information about medical care abroad, see Getting Health Care Abroad and a list of International Joint Commission-accredited facilities external icon .

How are typhoid fever and paratyphoid fever treated?

Typhoid fever and paratyphoid fever are treated with antibiotics.

Resistance to antibiotics is increasing pdf icon [PDF – 516 KB] in the bacteria that cause these diseases. When bacteria are resistant to antibiotics, the bacteria are not killed and their growth is not stopped when antibiotics are taken. Your doctor may order special tests to see if the bacteria causing your infection are resistant. Results from those tests may affect what antibiotic treatment you receive.

People who do not get appropriate antibiotic treatment may have fever for weeks or months and may develop complications. People who do not get treatment can die from complications of the infection.

The danger from typhoid fever or paratyphoid fever doesn’t end when symptoms disappear.

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi or Salmonella Paratyphi. If so, the illness could return, or you could pass the bacteria to other people. In fact, if you are a healthcare worker or work at a job where you handle food or care for small children, you may not be able to return to work until a doctor has determined you no longer carry the bacteria.

If you are being treated for typhoid fever or paratyphoid fever, it is important to do the following to lower the chance that you will pass the bacteria on to someone else.

  • Keep taking antibiotics for as long as the doctor has recommended.
  • Wash your hands carefully with soap and water after using the bathroom.
  • Do not prepare or serve food for other people.


  • 1 Central Laboratory, UDA Clinical Laboratories Diagnostic Center, School of Medicine, Pontificia Catholic University of Chile, Santiago.
  • PMID: 1478046
  • DOI: 10.1016/0732-8893(92)90066-3
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  • 1 Central Laboratory, UDA Clinical Laboratories Diagnostic Center, School of Medicine, Pontificia Catholic University of Chile, Santiago.
  • PMID: 1478046
  • DOI: 10.1016/0732-8893(92)90066-3


Serum samples from 85 patients with proven typhoid fever, 11 patients with p-typhoidal fever, 101 patients with febrile non-typhoidal, and 130 healthy subjects were tested for immunoglobulin G (IgG), IgA, and IgM antilipopolysaccharide (LPS) of Salmonella typhi antibodies by enzyme-linked immunosorbent assay (ELISA) and Widal test. The levels of all three classes of immunoglobulin anti-LPS of S. typhi were higher in typhoid patients than in healthy or febrile nontyphoidal groups; we selected various combinations between the three classes of immunoglobulin to obtain the best combination of sensitivity and specificity. The sum of the absorbance values obtained from the ELISA assay for IgG+IgA+IgM (sigma lgs) was the best choice for diagnostic utility for typhoid fever. We selected a positive test at a decision level of sigma lgs > or = 1.2 with a sensitivity of 94% and a specificity of 92% with a frequency of false negative of 5.9%. The frequency of false positives for healthy controls was 7.7% and, for the febrile nontyphoidal group, it was 7.9%. We also compared receiver (or relative) operating characteristic (ROC) curves for the diagnostic usefulness of the ELISA with that of the Widal test, whose merits and limitations, especially in endemic regions, are discussed. The ELISA assay was much more sensitive and specific than any combination of the Widal test, and hence it could be a useful tool for the serologic diagnosis of typhoidal fever with a single blood sample.