Typhoid fever is a serious infection caused by the bacterium Salmonella Typhi, spread through food and water contaminated with faeces. The World Health Organization estimates around 9 million cases and over 100,000 deaths a year, mostly in South Asia, Africa and parts of South-East Asia.
Many people have been told they have “typhoid” several times, based on a quick test that is often wrong. After reading this, you will know which test to ask for and why.
Symptoms
- A fever that rises over several days and lasts a week or more
- Tiredness and weakness
- Headache
- Abdominal pain
- Constipation or diarrhoea
- Loss of appetite
- Sometimes a faint rash of pink spots on the chest or abdomen
Seek urgent care for severe abdominal pain, vomiting blood, black stools, confusion or extreme drowsiness. These can be signs of complications such as bowel perforation.
Testing: why the Widal test misleads
In many countries, the quick Widal blood test is still widely used, but it gives many false positives and false negatives, leading to people being treated for typhoid they do not have, and real typhoid being missed. Blood culture is the recommended test, ideally taken before antibiotics.
Treatment
Typhoid is treated with antibiotics prescribed by a health professional. Drug resistance is a growing problem: extensively drug-resistant typhoid has spread in Pakistan, and resistance to older antibiotics is common worldwide. That is why the right test and the right antibiotic matter. Always finish the course, and do not use leftover antibiotics.
Prevention
- Drink safe water: boiled, treated or sealed bottled water
- Wash hands with soap after the toilet and before eating or preparing food
- Eat food that is thoroughly cooked and still hot
- Peel fruit yourself; avoid raw salads in high-risk areas
- Get vaccinated: WHO recommends typhoid conjugate vaccine for children in countries where typhoid is common, and vaccines are available for travellers
Can you carry typhoid without symptoms?
Yes. A small number of people continue to carry the bacteria after recovering, and can spread it, especially if they handle food. Follow-up stool tests may be needed for food handlers.
“But the Widal test is cheaper and faster, so why not use it?”
Because it is unreliable. False positives lead to unnecessary antibiotics and drug resistance, while real typhoid can be missed. Blood culture is the recommended test.
Your next step: if you have a fever lasting several days, ask whether a blood culture is possible before starting antibiotics, and share this guide with family.
Related: Signs of dehydration · Antimicrobial resistance
Source: World Health Organization, typhoid fact sheet and position paper on typhoid vaccines.
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