Typhoid fever

Author: Daniel Wong, Intern, Monash Medical Centre, Victoria, Australia. Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. March 2014.

What is typhoid fever?

Typhoid fever, also known as enteric fever, is an infection caused by Salmonella typhi. The symptoms of typhoid fever are nonspecific and can include:

What are paratyphoid fever and salmonellosis?

Paratyphoid fever is an infection caused by Salmonella paratyphi, and can present similarly to enteric fever.

Both typhoid and paratyphoid fever are examples of salmonellosis, where the infectious agent originates from the genus of motile bacteria with a gram-negative staining pattern on microscopy, Salmonella.

What are the risk factors for typhoid fever?

Typhoid fever is contracted through contact with infected individuals and chronic carriers of typhoid fever (who are in good health but salmonella bacteria can be found in their faeces). Salmonella bacteria primarily infect humans and are transmitted through ingestion of contaminated water or food. This usually occurs in developing countries with poor hygienic practices.

How is typhoid fever diagnosed?

Typically, individuals may have recently travelled to endemic areas (South East Asia, South America), ingested contaminated food or water, and experienced some of the symptoms listed above. The Salmonella bacteria can be found in faeces or blood. There may also be a rise in antibody levels observed in the blood.

What are rose spots?

Rose spots describe the rash that occurs in up to 30% of people infected with Salmonella typhi. Characteristically, rose spots are seen in untreated typhoid fever.

What is the cause of rose spots?

Rose spots are thought to be bacterial emboli to the skin, i.e. clumps of bacteria have spread through the bloodstream.

Rose spots have also been described in other infections (psittacosis, brucellosis, shigellosis, streptobacillosis, and leptospirosis).

What other skin changes are seen with typhoid fever?

Apart from rose spots, other rashes may arise in salmonella infections.

What treatment is used for typhoid fever?

Typhoid fever is a bacterial infection, so is treated with antibiotics.

However, S. Typhi is commonly resistant to several antibiotics, including cotrimoxazole, ampicillin, and chloramphenicol, and sometimes quinolones (eg ciprofloxacin).

Ceftriaxone, and azithromycin appear to be effective.

Can typhoid fever be prevented?

Prevention of typhoid fever is mainly achieved through vaccination and avoidance of high-risk foods.


Travellers to at risk countries, eg South America and South East Asia, are strongly recommended to be vaccinated in advance of travel. Two forms are available:

If vaccinated previously, immunity can be checked by a blood test. Vaccine effectiveness declines with time. A booster may be necessary.


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