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Typhoid Fever Treatment & Management

  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Feb 16, 2016
 

Medical Care

If a patient presents with unexplained symptoms described in Table 1 within 60 days of returning from an typhoid fever (enteric fever) endemic area or following consumption of food prepared by an individual who is known to carry typhoid, broad-spectrum empiric antibiotics should be started immediately. Treatment should not be delayed for confirmatory tests since prompt treatment drastically reduces the risk of complications and fatalities. Antibiotic therapy should be narrowed once more information is available.

Compliant patients with uncomplicated disease may be treated on an outpatient basis. They must be advised to use strict handwashing techniques and to avoid preparing food for others during the illness course. Hospitalized patients should be placed in contact isolation during the acute phase of the infection. Feces and urine must be disposed of safely.

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Surgical Care

Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations.

If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.

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Consultations

An infectious disease specialist should be consulted. Consultation with a surgeon is indicated upon suspected gastrointestinal perforation, serious gastrointestinal hemorrhage, cholecystitis, or extraintestinal complications (arteritis, endocarditis, organ abscesses).

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Diet

Fluids and electrolytes should be monitored and replaced diligently. Oral nutrition with a soft digestible diet is preferable in the absence of abdominal distension or ileus.

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Activity

No specific limitations on activity are indicated for patients with typhoid fever. As with most systemic diseases, rest is helpful, but mobility should be maintained if tolerable. The patient should be encouraged to stay home from work until recovery.

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Contributor Information and Disclosures
Author

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Roberto Corales, DO, AAHIVS Senior Director, HIV Medicine and Clinical Research, Trillium Health

Roberto Corales, DO, AAHIVS is a member of the following medical societies: American Medical Association, International AIDS Society, American Osteopathic Association

Disclosure: Nothing to disclose.

Steven K Schmitt, MD Staff Physician, Department of Infectious Disease, Cleveland Clinic

Steven K Schmitt, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas Garvey, MD, JD Primary Care Physician, Burlington Medical Associates; Co-chair, Medical Advisory Committee for the Elimination of Tuberculosis

Thomas Garvey, MD, JD is a member of the following medical societies: American College of Legal Medicine, American College of Physicians, American Society of Law, Medicine & Ethics

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Life cycle of Salmonella typhi.
Table 1. Incidence and Timing of Various Manifestations of Untreated Typhoid Fever[2, 31, 32, 33, 34, 35]
 IncubationWeek 1Week 2Week 3Week 4Post
SystemicRecovery phase or death (15% of untreated cases)10%-20% relapse; 3%-4% chronic carriers;



long-term neurologic sequelae (extremely rare);



gallbladder cancer (RR=167; carriers)



Stepladder fever pattern or insidious onset fever Very commonaVery common
Acute high fever Very rareb  
Chills Almost allc
Rigors Uncommon
Anorexia Almost all
Diaphoresis Very common
Neurologic
Malaise Almost allAlmost allTyphoid state (common)
Insomnia  Very common
Confusion/delirium CommondVery common
Psychosis Very rareCommon 
Catatonia Very rare  
Frontal headache



(usually mild)



 Very common  
Meningeal signs RareeRare 
Parkinsonism Very rare  
Ear, nose, and throat
Coated tongue Very common  
Sore throatf    
Pulmonary
Mild cough Common  
Bronchitic cough Common  
Rales Common  
Pneumonia Rare (lobar)RareCommon



(basal)



Cardiovascular
Dicrotic pulse RareCommon
Myocarditis Rare  
Pericarditis Extremely rareg  
Thrombophlebitis   Very rare
Gastrointestinal
Constipation Very commonCommon
Diarrhea RareCommon (pea soup)
Bloating with tympany Very common (84%)[35]   
Diffuse mild abdominal pain Very common  
Sharp right lower quadrant pain Rare  
Gastrointestinal hemorrhage Very rare; usually traceVery common
intestinal perforation   Rare
Hepatosplenomegaly Common
Jaundice Common
Gallbladder pain Very rare
Urogenital
Urinary retention Common
Hematuria Rare
Renal pain Rare
Musculoskeletal
MyalgiasVery rare
ArthralgiasVery rare
Rheumatologic
Arthritis (large joint)Extremely rare
Dermatologic
Rose spots Rare
Miscellaneous
Abscess (anywhere) Extremely rareExtremely rareExtremely rare
a Very common: Symptoms occur in well over half of cases (approximately 65%-95%).



b Very rare: Symptoms occur in less than 5% of cases.



c Almost all: Symptoms occur in almost all cases.



d Common: Symptoms occur in 35%-65% of cases.



e Rare: Symptoms occur in 5%-35% of cases.



f Blank cells: No mention of the symptom at that phase was found in the literature.



g Extremely rare: Symptoms have been described in occasional case reports.



Table 2. Sensitivities of Cultures[2, 37, 38, 39]
 IncubationWeek 1Week 2Week 3Week 4
Bone marrow aspirate (0.5-1 mL) 90% (may decrease after 5 d of antibiotics)
Blood (10-30 mL), stool, or duodenal aspirate culture40%-80%~20%Variable (20%-60%)
Urine 25%-30%, timing unpredictable
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