saudigastro.com/patients/typhoid-fever
Category
Serious
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Typhoid fever is caused by a bacterium called Salmonella Typhi. It lives only in humans and is spread by food or water contaminated with the stool or urine of an infected person, including people who carry the bacteria without symptoms. The infection spreads from the gut into the bloodstream and can affect many organs. A related illness, paratyphoid fever, is caused by a similar bacterium and is usually somewhat milder. Typhoid can be treated with antibiotics, but it can cause serious complications if treatment is delayed.
How common is it?
Typhoid is far less common in places with safe water, good sanitation and food hygiene. It remains more common in regions where these are limited, and travellers to such regions and people exposed to contaminated food or water are at higher risk. Children are often affected.
Why does it happen?
You catch typhoid by swallowing the bacteria in contaminated food or drink, for example unsafe water, ice made from unsafe water, raw or undercooked foods washed in unsafe water, or food handled by someone who carries the bacteria. It is not spread by coughing or casual contact. Poor hand-washing, unsafe water and inadequate sanitation allow it to spread.
Symptoms
- A fever that rises gradually over several days and stays high
- Headache, tiredness and general weakness
- Belly pain and loss of appetite
- Constipation or diarrhoea (diarrhoea is more common in young children)
- A dry cough in some people
- A faint pink rash on the chest or belly in some people
- In small children: irritability, poor feeding, vomiting or unusual sleepiness
Red flags — seek urgent medical care
A baby or child with high fever who is very sleepy, hard to wake, floppy, refusing fluids, breathing fast, or not passing urine
A child needing urgent care should be seen immediately. Take them to the emergency department now. Do not give home remedies, leftover antibiotics or adult medicines.
Severe belly pain with a rigid belly, vomiting, or sudden worsening
Typhoid can cause a hole in the bowel (perforation), usually in the second or third week. Go to the emergency department immediately.
Passing blood in the stool, black stools, dizziness or fainting
Typhoid can cause bowel bleeding. Go to the emergency department now.
Confusion, delirium, severe drowsiness, a stiff neck or seizures
Suggests the infection is affecting the brain or the body is severely unwell. Call emergency services.
Signs of dehydration: very dry mouth, little or no urine, sunken eyes, dizziness
You may need fluids through a vein. Seek care promptly, and straight away for a child.
Fever lasting more than a few days after travel, even if you feel only moderately unwell
Needs medical assessment and blood tests, and the doctor should be told about your travel and food or water exposure.
How is it diagnosed?
Diagnosis depends on finding the bacteria. A blood culture, taken before antibiotics are started when possible, is the most useful test early in the illness. Stool or urine cultures and bone marrow cultures are sometimes used, and blood tests may show a low white blood cell count or raised liver enzymes. Some blood antibody tests are used in certain places but are less reliable. Doctors also consider other causes of prolonged fever, such as malaria, other infections or typhus. Your doctor decides which tests you need, and the result guides the choice of antibiotic.
What the latest science says
Some typhoid bacteria have become resistant to commonly used antibiotics, so the choice of antibiotic is guided by culture and sensitivity results and by local resistance patterns. Typhoid vaccines are available and are recommended for travellers to higher-risk regions and for people at ongoing risk; they do not give complete protection, so food and water precautions still matter.
Outlook — what to expect
With early and appropriate antibiotic treatment most people recover, though recovery can take weeks and tiredness may linger. Without treatment, or if treatment is delayed, the illness can become severe with complications such as bowel bleeding or perforation. A small number of people continue to carry the bacteria after recovery and can pass it on to others, so follow-up stool tests may be advised, especially for people who handle food.
Treatment
Habits & Lifestyle
Suspected typhoid needs medical assessment, not home treatment. Hygiene also protects others.
- See a doctor promptly for a fever lasting more than a few days, and straight away for a baby or child who looks very unwell
- Wash hands thoroughly with soap and water after using the toilet, changing nappies and before preparing or eating food
- Avoid preparing food for others while ill, and until your doctor says it is safe
- Rest, and do not return to work or school until your doctor allows it, particularly if you handle food or care for others
- Do not take leftover or unprescribed antibiotics
Diet
Safe food and water are the key to prevention, and fluids matter during illness.
- Drink plenty of safe fluids; use oral rehydration solution for diarrhoea or vomiting, as advised
- When travelling to higher-risk areas, drink bottled or properly boiled or treated water, and avoid ice of unknown source
- Eat food that is freshly cooked and served hot; avoid raw salads and unpeeled fruit washed in unsafe water
- Choose pasteurised dairy products, and avoid food from street vendors if hygiene is uncertain
- Continue feeding babies (breast milk or formula) and children as advised by their doctor
Medications
Typhoid needs antibiotics chosen by a doctor, using culture and local resistance information.
- Take the antibiotic exactly as prescribed and finish the whole course, even if you feel better
- Severe cases are treated in hospital with intravenous antibiotics and fluids
- Fever and pain relief should be chosen with your doctor, and for children only with medical advice
- Tell your doctor if you are pregnant or breastfeeding, because the choice of antibiotic may differ
- Report if fever does not settle in the days after starting treatment; the antibiotic may need to be changed
Procedures & Surgery
Most people need no procedure, but complications may require one.
- Surgery is needed if the bowel perforates
- Blood transfusion or endoscopic treatment may be needed for significant bowel bleeding
- Hospital care with fluids and monitoring is used for more serious illness
- For long-term carriers, further tests or, rarely, gallbladder removal may be discussed by specialists
Living with the condition
- Recovery can take weeks. Rest, drink fluids and increase activity gradually.
- Your doctor may ask for follow-up stool tests, particularly if you work with food, health care or children.
- Household members should wash hands carefully and may be advised to be checked.
In the Saudi context
Pilgrims and other travellers to and from regions where typhoid is more common may be at risk. If you travel for Hajj, Umrah, work or family visits, speak to your doctor or a travel clinic before you go about vaccination and food and water precautions. If you develop a fever after returning, tell your doctor where you travelled.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Do I have typhoid or another cause of fever, and which tests do I need?
- Can I be treated at home or do I need to be admitted?
- How long should I take the antibiotic and what should I do if the fever does not settle?
- When can I return to work or school, and do I need follow-up stool tests?
- Should my family be checked or vaccinated?
- What vaccination and food and water precautions do you advise before I travel?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide