Typhoid Fever

Typhoid fever is a bacterial infection that is common in many parts of the world. It is spread by contaminated water and food and primarily affects the digestive system.

What Is Typhoid?

In many developing countries, typhoid fever is a major problem. An estimated 21 million are infected and more than 200,000 die each year worldwide. The disease is especially common in parts of Asia, Africa, and South America where pure water is not readily available and sewage treatment is inadequate. In many countries, children are the most likely to get typhoid.

Three-dimensional (3D) computergenerated image of drug-resistant Salmonella serotype Typhi bacteria that causes typhoid fever. People with typhoid fever usually have a high fever, abdominal pain, and headache.

Three-dimensional (3D) computergenerated image of drug-resistant Salmonella serotype Typhi bacteria that causes typhoid fever. People with typhoid fever usually have a high fever, abdominal pain, and headache. Typhoid fever can lead to bowel perforation, shock, and death. Physicians rely on drugs such as ceftriaxone, azithromycin, and ciprofloxacin for treating patients with typhoid fever; however, Salmonella serotype Typhi has been showing some resistance to these antibiotics, and thus these antibiotics cannot be routinely used to treat typhoid fever.
CDC/James Archer.

What Causes Typhoid Fever?

Typhoid fever is caused by a bacterium called Salmonella typhi. It is related to the Salmonella bacteria that cause food poisoning, but they are not exactly the same.

S. typhi bacteria are present in the solid wastes (stool) of infected people, including some “healthy carriers” who have no symptoms of illness. The bacteria can spread if human waste gets into water that is used for drinking, irrigating crops, or washing food. Typhoid is also occasionally transmitted through an infected person who is working in food preparation. Once swallowed, the bacteria move from the digestive tract into the bloodstream and then to the liver * , spleen * , gallbladder * , and lymph nodes * .

What Happens When People Have Typhoid Fever?


The symptoms of typhoid fever come on gradually. At first, people may get a headache, stomachache, and constipation *

The United States and the World

About 21.5 million cases of typhoid fever occur each year worldwide, and more than 200,000 people die from this disease.

The disease is common in many underdeveloped nations, especially in parts of Asia and in South America, with unsanitary water and food preparation. The situation is made more difficult because the disease shows resistance to some of the traditional antibiotics used to treat those who are infected.

About 5,700 cases a year are reported in the United States, but about 75 percent of them involve people who have traveled internationally.

In 1998 and 1999, 13 people in Florida contracted typhoid fever when they drank shakes made with a frozen tropical fruit containing Salmonella typhi.

Typhoid fever is suspected in the deaths of such famous people as Alexander the Great, Wilbur Wright of the Wright Brothers, and poet Gerard Manley Hopkins.


Some people, called carriers, can be infected with Salmonella typhi but not develop typhoid fever. If they prepare food for others, however, they may contaminate the food they handle and pass the bacteria on to other people who eat it and then may get sick.

The most famous typhoid carrier was Mary Mallon (1869–1938), also known as Typhoid Mary, who worked as a cook in homes in New York and New Jersey in the early 1900s. Fifty-one cases of typhoid fever resulting in three deaths were traced to her. Mallon never was sick herself, however, and she never accepted that she had infected anyone else.

Against her will, the authorities confined Mallon to a hospital on North Brother Island in New York's East River. Three years later, in 1910, they released her on condition that she never work as a cook again. But in 1915 typhoid struck a maternity hospital in Manhattan, and it turned out that Mallon had cooked there. She spent the rest of her life, 23 years, as a captive on North Brother Island.

Diagnosis and treatment

A blood or urine test can usually detect the presence of the bacterium that causes typhoid fever. Antibiotic drugs that fight the bacterial infection can make the illness shorter and milder and prevent complications. Fluids may be given as well to counter the effects of diarrhea. Severe infections can lead to a perforation (hole) in the intestine that requires surgery to repair.

How Is Typhoid Fever Prevented?

Clean water supplies and effective waste disposal systems are the best ways of preventing typhoid, but these are lacking in many countries. As of 2015, two types of vaccines are available, and both require boosters every three to five years.

Travelers to countries where typhoid fever is common should drink only boiled or bottled water. They should eat only food that has been properly cooked or fruit that they peel themselves and that has not been washed with tap water. The Centers for Disease Control and Prevention sums up advice for travelers this way: “Boil it, cook it, peel it, or forget it.”

See also Bacterial Infections • Fever • Gastroenteritis • Salmonellosis


Books and Articles

Bartoletti, Susan Campbell. Terrible Typhoid Mary: A True Story of the Deadliest Cook in America. New York: Houghton Mifflin Harcourt, 2015.

Jarrow, Gail. Fatal Fever: Tracking Down Typhoid Mary. Honesdale, PA: Calkins Creek, 2015.

Klein, Christopher. “Ten Things You May Not Know About ‘Typhoid Mary.’” History, March 27, 2015. http://www.history.com/news/10-things-you-may-not-know-about-typhoid-mary (accessed November 18, 2015).

Kupferschmidt, Kai. “Drug-Resistant Typhoid Fever Becoming an Epidemic in Africa and Asia.” Science Mag, May 11, 2015. http://news.sciencemag.org/biology/2015/05/drug-resistanttyphoid-fever-becoming-epidemic-africa-and-asia (accessed November 18, 2015).

Morley, Jacqueline. You Wouldn't Want to Meet Typhoid Mary! London: Franklin Watts, 2013.


MedlinePlus. “Typhoid Fever.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/001332.htm (accessed November 18, 2015).

NYC Health. “Typhoid Fever.” New York City Health and Mental Hygiene. http://www.nyc.gov/html/doh/html/diseases/cdtyp.shtml (accessed November 18, 2015).


National Center for Emerging and Zoonotic Infectious Diseases. 1600 Clifton Rd., Atlanta, GA, 30329-4027. Toll-free: 888-674-6854. Website: http://www.cdc.gov/ncezid (accessed November 18, 2015).

World Health Organization. 525 Twenty-Third St. NW, Washington, DC 20037. Telephone: 202-974-3000. Website: http://www.who.int/en/ (accessed November 18, 2015).

* liver is a large organ located beneath the ribs on the right side of the body. The liver performs numerous digestive and chemical functions essential for health.

* spleen is an organ in the upper left part of the abdomen that stores and filters blood. As part of the immune system, the spleen also plays a role in fighting infection.

* gallbladder is a small pearshaped organ on the right side of the abdomen that stores bile, a liquid that helps the body digest fat.

* lymph nodes (LIMF) are small, bean-shaped masses of tissue containing immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections.

* constipation is the sluggish movement of the bowels, usually resulting in infrequent, hard stools.

  This information is not a tool for self-diagnosis or a substitute for professional care.