Typhoid fever, also known as typhoid, is a disease caused by Salmonella serotype Typhi bacteria.[2] Symptoms may vary from mild to severe, and usually begin six to 30 days after exposure.[3][4] Often there is a gradual onset of a high fever over several days.[3] This is commonly accompanied by weakness, abdominal pain, constipation, headaches, and mild vomiting.[4][5] Some people develop a skin rash with rose colored spots.[4] In severe cases, people may experience confusion.[5] Without treatment, symptoms may last weeks or months.[4] Diarrhea is uncommon.[5] Other people may carry the bacterium without being affected, but they are still able to spread the disease to others.[6] Typhoid fever is a type of enteric fever, along with paratyphoid fever.[2] So far, S. enterica Typhi is only known to infect and replicate within humans.[7]

The cause is the bacterium Salmonella enterica subsp. enterica serovar Typhi growing in the intestines, peyers patches, mesenteric lymph nodes, spleen, liver, gallbladder, bone marrow and blood.[4][5] Typhoid is spread by eating or drinking food or water contaminated with the feces from an infected person.[6] Risk factors include limited access to clean drinking water, and poor sanitation.[2] Those who have not yet been exposed to the pathogen and ingest contaminated drinking water or food are most at risk for developing symptoms.[5] As far as we currently know, only humans can be infected; there are no known animal reservoirs.[6] Diagnosis is by culturing and identifying the Salmonella enterica Typhi bacterium from patient samples or detecting an immune response to the pathogen from blood samples.[4][2][8] Recently, new advances in large-scale data collection and analysis are allowing researchers to develop better diagnostics - such as detecting changing abundances of small molecules in the blood that may specifically indicate typhoid fever.[9] Diagnostic tools in regions where typhoid is most prevalent are quite limited in terms of accuracy and specificity; the time required for a proper diagnosis, increasing spread of antibiotic resistance, and the cost of testing is also a concern for under-resourced healthcare systems.[7]

A typhoid vaccine can prevent about 40 to 90% of cases during the first two years.[10] The vaccine may have some effect for up to seven years.[2] For those at high risk or people traveling to areas where the disease is common, vaccination is recommended.[6] Other efforts to prevent the disease include providing clean drinking water, good sanitation, and handwashing.[4][6] Until an individual's infection is confirmed as cleared, the individual should not prepare food for others.[4] The disease is treated with antibiotics such as azithromycin, fluoroquinolones, or third-generation cephalosporins.[2] Resistance to these antibiotics has been developing, which has made treatment of the disease more difficult.[2][11]

In 2015, 12.5 million new cases worldwide were reported.[12] The disease is most common in India.[2] Children are most commonly affected.[2][6] Rates of disease decreased in the developed world in the 1940s as a result of improved sanitation and use of antibiotics to treat the disease.[6] Each year in the United States, about 400 cases are reported and the disease occurs in an estimated 6,000 people.[5][13] In 2015, it resulted in about 149,000 deaths worldwide – down from 181,000 in 1990 (about 0.3% of the global total).[14][15] The risk of death may be as high as 20% without treatment.[6] With treatment, it is between 1 and 4%.[2][6]

Typhus is a different disease.[16] Due to the similarity in symptoms, they were not recognized as distinct diseases until the 1800s. The name typhoid means "resembling typhus".[17]

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