Enteric Fever

Overview

Enteric fever is the medical term for the systemic illness caused by Salmonella enterica serotypes Typhi and Paratyphi. It includes both typhoid fever (caused by Salmonella Typhi) and paratyphoid fever (caused by Salmonella Paratyphi). The bacteria are swallowed in food or water contaminated with the feces of an infected person and then spread through the body.

Unlike ordinary food poisoning, which mainly causes short-lived diarrhea, enteric fever produces a prolonged, gradually rising fever and affects the whole body. It remains common in parts of the world with limited access to clean water and good sanitation, and it is often acquired during travel to these regions. With prompt antibiotic treatment most people recover well, but untreated infection can be life-threatening.

Symptoms

Symptoms usually develop gradually over one to three weeks after infection and tend to build in intensity. Typical features include:

• A sustained fever that often rises step by step each day
• Headache and body aches
• Marked weakness and fatigue
• Loss of appetite
• Abdominal pain and discomfort
• Constipation or diarrhea
• A faint rash of rose-colored spots in some people

If untreated, the illness can persist for weeks and lead to dangerous complications such as intestinal bleeding or a perforation of the bowel wall. Severe abdominal pain, bloody or black stools, confusion, or signs of severe dehydration require emergency care.

Causes

Enteric fever is caused by Salmonella Typhi or Paratyphi, bacteria that live only in humans. The infection spreads through the fecal-oral route:

• Contaminated water: Drinking water mixed with sewage.
• Contaminated food: Food handled by an infected person with unwashed hands or prepared with unsafe water.
• Carriers: Some people continue to shed the bacteria long after recovering and can unknowingly infect others, especially if they handle food.

The disease thrives where sanitation is poor and safe drinking water is scarce.

Risk Factors

• Living in or traveling to areas with poor sanitation
• Drinking untreated water or eating food from unsafe sources
• Close contact with an infected person or a chronic carrier
• Working in sanitation or with sewage
• Limited access to handwashing facilities

Diagnosis

Because the early symptoms resemble many other infections, laboratory tests are needed to confirm enteric fever:

• Blood culture: Growing the bacteria from a blood sample is the main confirmatory test, especially in the first week.
• Stool and urine cultures: Often positive later in the illness.
• Bone marrow culture: The most sensitive test, sometimes used when blood cultures are negative.

A history of recent travel and a gradually rising fever help guide the diagnosis.

Treatment

Enteric fever is treated with antibiotics, supported by good hydration and rest.

• Antibiotics: A course of antibiotics clears the infection. Because resistance is increasing in some regions, the choice is guided by local patterns and laboratory results.
• Fluids: Adequate fluids, taken by mouth or given intravenously in hospital, prevent and treat dehydration.
• Rest and nutrition: Support recovery during the prolonged illness.
• Hospital monitoring: Severe cases are watched closely for complications such as bleeding or perforation.

It is important to complete the full antibiotic course, both to clear the infection and to reduce the chance of becoming a long-term carrier.

Prevention

• Get a typhoid vaccine before traveling to high-risk areas, as advised by a travel clinic
• Drink only bottled, boiled, or properly treated water
• Eat food that is freshly cooked and served hot, and peel fruit yourself
• Avoid ice, raw vegetables, and street food in high-risk areas
• Wash hands thoroughly with soap before eating and after using the toilet
• If you have been infected, follow advice on testing to confirm you no longer carry the bacteria before handling food for others

When to See a Doctor

See a doctor if you develop a sustained or rising fever, particularly after traveling to an area where enteric fever is common. Seek emergency care for severe abdominal pain, vomiting blood or passing black or bloody stools, persistent vomiting, confusion, or signs of severe dehydration, as these may indicate serious complications.

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Typhoid and Paratyphoid Fever.
2. World Health Organization (WHO). Typhoid.
3. MedlinePlus, U.S. National Library of Medicine. Typhoid fever.
4. Mayo Clinic. Typhoid fever.