Diagnosis

Medical and travel history

Your health care provider may suspect typhoid fever based on your symptoms, and your medical and travel history. The diagnosis is often confirmed by growing the Salmonella enterica serotype typhi in a sample of your body fluid or tissue.

Body fluid or tissue culture

A sample of your blood, stool, urine or bone marrow is used. The sample is placed in an environment where bacteria grow easily. The growth, called a culture, is checked under a microscope for the typhoid bacteria. A bone marrow culture often is the most sensitive test for Salmonella typhi.

A culture test is the most common diagnostic test. But other testing may be used to confirm typhoid fever. One is a test to detect antibodies to typhoid bacteria in your blood. Another test checks for typhoid DNA in your blood.


Treatment

Antibiotic therapy is the only effective treatment for typhoid fever.

Commonly prescribed antibiotics

The medicine you get to treat typhoid fever may depend on where you picked up the bacteria. Strains picked up in different places respond better or worse to certain antibiotics. These medicines may be used alone or together. Antibiotics that may be given for typhoid fever are:

  • Fluoroquinolones. These antibiotics, including ciprofloxacin (Cipro), may be a first choice. They stop bacteria from copying themselves. But some strains of bacteria can live through treatment. These bacteria are called antibiotic resistant.
  • Cephalosporins. This group of antibiotics keeps bacteria from building cell walls. One kind, ceftriaxone, is used if there is antibiotic resistance.
  • Macrolides. This group of antibiotics keeps bacteria from making proteins. One kind called azithromycin (Zithromax) can be used if there is antibiotic resistance.
  • Carbapenems. These antibiotics also prevent bacteria from building cell walls. But they focus on a different stage of that process than the cephalosporins. Antibiotics in this category may be used with severe disease that doesn't respond to other antibiotics.

Other treatments

Other treatments include:

  • Drinking fluids. This helps prevent the dehydration caused by a long fever and diarrhea. If you're very dehydrated, you may need to receive fluids through a vein.
  • Surgery. If the intestines are damaged, you may need surgery to repair them.

Preparing for your appointment

Call your health care provider if you have symptoms of typhoid fever. This is especially important if you or a close companion recently traveled to a place that has a high risk of typhoid fever. If your symptoms are severe, go to an emergency room or call 911 or your local emergency number.

Here's some information to help you get ready and know what to expect from your health care provider.

Information to gather in advance

  • Pre-appointment restrictions. At the time you make your appointment, ask if there are restrictions you need to follow in the time leading up to your visit. Your health care provider will not be able to confirm typhoid fever without a blood test. The provider may suggest actions you can take to lower the risk that you'll spread the bacteria to someone else.
  • Symptom history. Write down any symptoms you're experiencing and for how long.
  • Recent exposure to possible sources of infection. Be prepared to describe international trips in detail, including the countries you visited and the dates you traveled.
  • Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medications, vitamins or supplements you're taking. Your provider also will need to know your vaccination history.
  • Questions to ask your health care provider. Write down your questions in advance so that you can make the most of your time with your provider.

For typhoid fever, possible questions to ask your provider include:

  • What are the possible causes for my symptoms?
  • What kinds of tests do I need?
  • Are treatments available to help me recover?
  • I have other health problems. How can I best manage these conditions together?
  • How long do you expect a full recovery will take?
  • When can I return to work or school?
  • Am I at risk of any long-term complications from typhoid fever?

Don't hesitate to ask any other related questions you have.

What to expect from your doctor

Your provider is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your provider may ask:

  • What are your symptoms and when did they begin?
  • Have your symptoms gotten better or worse?
  • Did your symptoms briefly get better and then come back?
  • Have you recently traveled abroad? Where?
  • Did you update your vaccinations before traveling?
  • Are you being treated for any other medical conditions?
  • Are you currently taking any medications?

Jan 28, 2023

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  6. CDC health advisory: Extensively drug-resistant Salmonella typhi infections among U.S. residents without international travel. Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/2021/han00439.asp. Accessed Dec. 16, 2022.
  7. Typhoid fact sheet. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/typhoid. Accessed Dec. 19, 2022.
  8. Your health abroad. U.S. Department of State, Bureau of Consular Affairs. https://travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad.html. Accessed Dec. 19, 2022.
  9. Goldman L, et al., eds. Salmonella infections (including enteric fever). In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 16, 2022.
  10. Typhoid fever. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/typhoid-fever#. Accessed Dec. 16, 2022.

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