Typhoid and paratyphoid fever: a clinical seminar


Abi Manesh, DM, Eyal Meltzer, MD, Celina Jin, MBBS, Carl Britto, PhD, Divya Deodhar, MD, Sneha Radha, MD, Eli Schwartz, MD, Priscilla Rupali, MD


Rationale for review

Enteric fever (EF) caused by Salmonella enterica subspecies enterica serovar Typhi (Salmonella Typhi) & S. Paratyphi (Salmonella Paratyphi) remains an important cause of infectious morbidity and mortality in many low-income countries, and therefore still poses a major infectious risk for travelers to endemic countries.

Main findings

Although the global burden of EF has decreased over the past two decades, prevalence of EF remains high in Asia and Africa, with the highest prevalence reported from the Indian subcontinent. These statistics are mirrored by data on travel-related EF. Widespread and increasing antimicrobial resistance has narrowed treatment options for travel-related EF. Ceftriaxone and azithromycin-based therapies are commonly used, even with the emergence of extremely drug resistant (XDR) typhoid in Pakistan. Preventive measures among locals and travelers include provision of safe food and water and vaccination. Food and water precautions offer limited protection and the efficacy of Salmonella Typhi vaccines are only moderate signifying the need for travelers to be extra cautious.


Improvement in the diagnosis of typhoid with high degree of clinical suspicion, better diagnostic assays, early and accurate detection of resistance, therapy with appropriate drugs, improvements in hygiene and sanitation with provision of safe drinking water in endemic areas and vaccination among travellers as well as in the endemic population are keys to controlling typhoid. While typhoid vaccines are recommended for travellers to high risk areas, moderate efficacy and inability to protect against Salmonella Paratyphi are limitations to bear in mind. Improved Salmonella Typhi vaccines and vaccines against Salmonella Paratyphi A are required.

Click here to read the article, published in the Journal of Travel Medicine.