Typhoid (enteric) fever

Typhoid (enteric) fever mostly occurs in low-income countries where sanitary conditions remain poor and water supplies are not treated.

Transmission occurs through consumption of contaminated food or water.

In high-income countries, enteric fever is mainly seen among travellers returning from endemic areas.

Prolonged febrile illness with normal white blood cell count in returnees from an endemic area should increase suspicion.

Definitive diagnosis depends on bacterial isolation, usually by blood culture.

Choice of antibiotic treatment depends on antibiotic resistance patterns, travel history, and disease severity.

Several vaccines are available that provide some protection against Salmonella typhi. The newer conjugated vaccines provide higher protection, though not all vaccines are available in all countries. Current vaccines do not provide protection against S paratyphi.

Typhoid fever is a faecal-oral transmissible disease caused by the bacterium Salmonella enterica, serotype typhi. A similar clinical syndrome, paratyphoid fever, is caused by Salmonella enterica, serotype paratyphi, and the terms enteric fever and typhoid infection are used to describe both diseases. Unless otherwise stated, the information presented here will relate to both diseases.