Diagnosis

Medical and travel history

Your doctor is likely to suspect typhoid fever based on your symptoms and your medical and travel history. But the diagnosis is usually confirmed by identifying S. typhi in a culture of your blood or other body fluid or tissue.

Body fluid or tissue culture

For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. The culture is checked under a microscope for the presence of typhoid bacteria. A bone marrow culture often is the most sensitive test for S. typhi.

Although performing a culture test is the mainstay for diagnosis, in some instances other testing may be used to confirm a suspected typhoid fever infection, such as a test to detect antibodies to typhoid bacteria in your blood or a test that checks for typhoid DNA in your blood.

Treatment

Antibiotic therapy is the only effective treatment for typhoid fever.

Commonly prescribed antibiotics

  • Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for nonpregnant adults.
  • Ceftriaxone (Rocephin). This injectable antibiotic is an alternative for people who may not be candidates for ciprofloxacin, such as children.

These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

Problems with antibiotic resistance

In the past, the drug of choice was chloramphenicol. Doctors no longer commonly use it, however, because of side effects, a high rate of health deterioration after a period of improvement (relapse) and widespread bacterial resistance.

In fact, the existence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid fever, especially in the developing world. In recent years, S. typhi also has proved resistant to trimethoprim-sulfamethoxazole and ampicillin.

Other treatments

Other treatments include:

  • Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you're severely dehydrated, you may need to receive fluids through a vein (intravenously).
  • Surgery. If your intestines become perforated, you'll need surgery to repair the hole.

Preparing for your appointment

Call your doctor if you've recently returned from travel abroad and develop mild symptoms similar to those that occur with 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 doctor.

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 doctor will not be able to confirm typhoid fever without a blood test, and may recommend taking steps to reduce the risk of passing a possible contagious illness to others.
  • 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 doctor will also need to know your vaccination history.
  • Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.

For typhoid fever, possible questions to ask your doctor 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 doctor 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 doctor 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?
July 11, 2015
References
  1. Wain J, et al. Typhoid fever. The Lancet. 2015;385:1136.
  2. Longo DL, et al., eds. Salmonellosis In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: The McGraw-Hill Companies; 2015. http://www.accessmedicine.com. Accessed June 10, 2015.
  3. Typhoid fever. Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever. Accessed June 10, 2015.
  4. Hohmann EL. Epidemiology, microbiology, clinical manifestations, and diagnosis of typhoid fever. http://www.uptodate.com/home. Accessed June 10, 2015.
  5. Hohmann EL. Treatment and prevention of typhoid fever. http://www.uptodate.com/home. Accessed June 10, 2015.
  6. Anwar E, et al. Vaccines for preventing typhoid fever. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001261.pub3/abstract. Accessed June 10, 2015.