©2018 WebMD, Inc. All rights reserved. eMedicineHealth does not provide medical advice, diagnosis or treatment. See Additional Information.

Symptoms and Signs of Typhoid Fever (Enteric Fever)

Doctor's Notes on Typhoid Fever (Enteric Fever)

Typhoid fever (Enteric fever) is a potentially life-threatening infectious disease caused by Salmonella typhi bacteria that can, if untreated, have a 10-30% mortality rate due to intestinal hemorrhage or perforation. The classic signs and symptoms are a sustained high fever (103-104 F), fatigue, loss of appetite and headache. Untreated, the symptoms can last for months in some individuals. Other signs and symptoms include a slow heart rate, abdominal pains, diarrhea and/or constipation; some patients develop a rash on their chest and abdomen (flat and rose-colored rash termed rose spots) and some have enlarged livers and spleens.

The cause of typhoid fever is infection with the bacterium Salmonella typhi . The bacteria are ingested in contaminated food or fluids, enter ileal tissue, survive in macrophage cells, are carried to the lymphatic system and then can enter the blood. Some Salmonella typhi reach the gall bladder and then are shed into the feces, ready to infect others; some people become carriers; they shed bacteria but do not have active signs or symptoms.

Medical Author:
Medically Reviewed on 3/11/2019

Typhoid Fever (Enteric Fever) Symptoms

The classic symptom of typhoid fever is sustained fevers as high as 103 F-104 F (37.5 C-38 C). The fever is minimal in the first few days of the illness and increases over time to high fevers. Other common symptoms include

  • weakness,
  • generalized malaise (exhaustion and fatigue),
  • headache,
  • relatively slow heart rate (brachycardia) compared to the high fever (pulse-temperature disassociation),
  • stomach pains (abdominal pain),
  • diarrhea,
  • constipation,
  • loss of appetite.

Some patients will also have a distinctive rash on their chest and abdomen, which is rose-colored and flat (rose spots). Some patients will have an enlarged liver and spleen (hepatosplenomegaly). If left untreated, the illness last approximately one month and carries a 10%-30% mortality rate, which is usually due to intestinal hemorrhage or perforation.

Typhoid Fever (Enteric Fever) Causes

Typhoid fever is caused by a bacterium, Salmonella typhi. These bacteria adhere to ileal tissue in the GI tract, survive in macrophage cells, are carried to mesenteric lymph nodes, and reach the lymphatic system. They are further carried to the liver, spleen, and bone marrow. The bacteria then break out of the macrophages and enter the blood; some reach the gallbladder and then go into the GI tract where some are shed with the feces and others infect the patient through the GI tract.

Bacterial Infections 101 Types, Symptoms, and Treatments Slideshow

Bacterial Infections 101 Types, Symptoms, and Treatments Slideshow

Bacteria are microscopic, single-cell organisms that live almost everywhere. Bacteria live in every climate and location on earth. Some are airborne while others live in water or soil. Bacteria live on and inside plants, animals, and people. The word "bacteria" has a negative connotation, but bacteria actually perform many vital functions for organisms and in the environment. For example, plants need bacteria in the soil in order to grow.

The vast majority of bacteria are harmless to people and some strains are even beneficial. In the human gastrointestinal tract, good bacteria aid in digestion and produce vitamins. They also help with immunity, making the body less hospitable to bad bacteria and other harmful pathogens. When considering all the strains of bacteria that exist, relatively few are capable of making people sick.


Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.