Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. enterica serotype Paratyphi A, B, or C can cause a similar syndrome. Up to 20 million new cases of typhoid fever occur each year worldwide, most commonly in undeveloped areas with poor sanitation. Transmission occurs through the fecal-oral route, and humans are the only known reservoir. Complications of typhoid fever include intestinal hemorrhage, pericarditis, visceral abscesses, and septicemia. Treatment is dependent on patterns of antimicrobial resistance, but options include azithromycin and fluoroquinolones. Prevention of typhoid fever is available through vaccination, hand hygiene, and safe food and water practices.
Last updated: Sep 10, 2025
S. Typhimurium
Image: “Salmonella typhi“ by Roinujs. License: CC BY-SA 4.0After ingestion of Salmonella Salmonella Salmonellae are gram-negative bacilli of the family Enterobacteriaceae. Salmonellae are flagellated, non-lactose-fermenting, and hydrogen sulfide-producing microbes. Salmonella enterica, the most common disease-causing species in humans, is further classified based on serotype as typhoidal (S. typhi and paratyphi) and nontyphoidal (S. enteritidis and typhimurium). Salmonella Typhi:
This photomicrograph reveals some of the histopathology exhibited in a lymph node tissue specimen in a case of typhoid fever. Macrophages are present amongst the normal lymphocytes. Note, S. Typhi bacterial invasion of macrophages. These macrophages also contain erythrocytes and degenerated lymphocytes.
Image: “2213” by CDC/ Armed Forces Institute of Pathology, Charles N. Farmer.License: Public DomainInfection with S. Typhi results in typhoid Typhoid Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome. Enteric Fever (Typhoid Fever) (or enteric) fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever. Typhoid Typhoid Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome. Enteric Fever (Typhoid Fever) fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever is a severe systemic illness associated with fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever (cardinal symptom) and abdominal pain Abdominal Pain Acute Abdomen.[1,2,4,9,13]
Clinical course | Findings | |
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Week 1 | Bacteremia Bacteremia The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. Glycopeptides |
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Week 2 |
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Week 3 |
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Clinical features of week 2 plus:
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Rose spot rash on the trunk of a patient with typhoid fever
Image: “Rose-spot rash on the trunk of a patient with typhoid fever” by CDC/Armed Forces Institute of Pathology, Charles N. Farmer. License: CC0 1.0Rose spot rash on the nose of a patient with typhoid fever
Image: “Nevus araneus (spider nevus)” by M. Sand, D. Sand et al. License: CC BY 2.0Multiple ileal perforations in a patient with typhoid fever
Image: “Multiple typhoid ileal perforations” by Caronna R, Boukari AK et al. License: CC BY 2.0Diagnosis is dependent on a high degree of suspicion as cultures are often negative, take many days, and may not be available in resource-poor areas.
Treatment options may vary based on practice location. The following information was gleaned from US and UK guidelines.
Medication | Typical adult dose | Typical pediatric dose | Duration |
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Ciprofloxacin Ciprofloxacin A broad-spectrum antimicrobial carboxyfluoroquinoline. Fluoroquinolones | 500 mg every 12 hours | 30 mg/kg/day in 2 divided doses | 7–10 days |
Azithromycin Azithromycin A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. Macrolides and Ketolides | 1 g daily (OR 1 g on day 1, followed by 500 mg daily) | 10 mg/kg/dose daily Maximum: 500 mg/dose |
5–7 days |
Cefixime | 200 mg 2 times daily | 20 mg/kg in 2 divided doses Maximum 400 mg/day |
7–14 days |
Medication | Typical adult dose | Typical pediatric dose | Duration |
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Ceftriaxone Ceftriaxone A broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears. Cephalosporins | 2 g every 12–24 hours | 50–100 mg/kg in 1–2 divided doses Maximum: 4g/day |
10–14 days |
Cefotaxime Cefotaxime Semisynthetic broad-spectrum cephalosporin. Cephalosporins | 1–2 g every 6–8 hours | 150–200 mg/kg in 3–4 divided doses Maximum: 8g/day |
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Meropenem Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than imipenem, but does not need to be given with an enzyme inhibitor such as cilastatin. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. Carbapenems and Aztreonam | 1–2 g every 8 hours | 20–40 mg/kg every 8 hours | |
Azithromycin Azithromycin A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. Macrolides and Ketolides | 1 g on day 1, followed by 500 mg daily | 10 mg/kg daily Maximum: 500 mg/dose |
7 days |
Diagnosis Codes:
This code is used to diagnose
enteric fever
Enteric Fever
Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome.
Enteric Fever (Typhoid Fever), also known as
typhoid
Typhoid
Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome.
Enteric Fever (Typhoid Fever)
fever
Fever
Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.
Fever, a systemic illness caused by the bacterium
Salmonella Typhi
Salmonella typhi
A serotype of Salmonella enterica which is the etiologic agent of typhoid fever.
Enteric Fever (Typhoid Fever).
Coding System | Code | Description |
---|---|---|
ICD-10-CM | A01.00 | Typhoid Typhoid Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome. Enteric Fever (Typhoid Fever) fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, unspecified |
SNOMED CT | 48484004 | Typhoid Typhoid Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome. Enteric Fever (Typhoid Fever) fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever (disorder) |
Evaluation & Workup:
This CPT code is for a blood culture, which is the gold standard for diagnosing
typhoid
Typhoid
Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome.
Enteric Fever (Typhoid Fever)
fever
Fever
Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.
Fever by isolating S. Typhi from the patient’s bloodstream.
Coding System | Code | Description |
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CPT | 87040 | Culture, bacterial; blood, aerobic, with isolation and presumptive identification Identification Defense Mechanisms of isolates |
Medications:
These codes are for the antibiotics used to treat
typhoid
Typhoid
Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome.
Enteric Fever (Typhoid Fever)
fever
Fever
Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.
Fever.
Fluoroquinolones
Fluoroquinolones
Fluoroquinolones are a group of broad-spectrum, bactericidal antibiotics inhibiting bacterial DNA replication. Fluoroquinolones cover gram-negative, anaerobic, and atypical organisms, as well as some gram-positive and multidrug-resistant (MDR) organisms.
Fluoroquinolones like
ciprofloxacin
Ciprofloxacin
A broad-spectrum antimicrobial carboxyfluoroquinoline.
Fluoroquinolones or third-generation
cephalosporins
Cephalosporins
Cephalosporins are a group of bactericidal beta-lactam antibiotics (similar to penicillins) that exert their effects by preventing bacteria from producing their cell walls, ultimately leading to cell death. Cephalosporins are categorized by generation and all drug names begin with “cef-” or “ceph-.”
Cephalosporins like
ceftriaxone
Ceftriaxone
A broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears.
Cephalosporins are common choices, depending on regional
resistance
Resistance
Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow.
Ventilation: Mechanics of Breathing patterns.
Coding System | Code | Description |
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RxNorm | 2551 | Ciprofloxacin Ciprofloxacin A broad-spectrum antimicrobial carboxyfluoroquinoline. Fluoroquinolones (ingredient) |
RxNorm | 2240 | Ceftriaxone Ceftriaxone A broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears. Cephalosporins (ingredient) |
Complications:
This code is for
intestinal perforation
Intestinal perforation
Perforated viscus or GI perforation represents a condition in which the integrity of the GI wall is lost with subsequent leakage of enteric contents into the peritoneal cavity, resulting in peritonitis. The causes of perforated viscus include trauma, bowel ischemia, infections, or ulcerative conditions, all of which ultimately lead to a full-thickness disruption of the intestinal wall.
Perforated Viscus, a life-threatening complication of severe
typhoid
Typhoid
Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome.
Enteric Fever (Typhoid Fever)
fever
Fever
Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.
Fever where ulcers in the
small intestine
Small intestine
The small intestine is the longest part of the GI tract, extending from the pyloric orifice of the stomach to the ileocecal junction. The small intestine is the major organ responsible for chemical digestion and absorption of nutrients. It is divided into 3 segments: the duodenum, the jejunum, and the ileum.
Small Intestine: Anatomy erode through the bowel wall.
Coding System | Code | Description |
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ICD-10-CM | A01.03 | Typhoid Typhoid Typhoid (or enteric) fever is a severe, systemic bacterial infection classically caused by the facultative intracellular and Gram-negative bacilli Salmonella enterica serotype Typhi (S. Typhimurium, formerly S. typhi). S. paratyphi serotypes A, B, or C can cause a similar syndrome. Enteric Fever (Typhoid Fever) fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever with intestinal perforation Intestinal perforation Perforated viscus or GI perforation represents a condition in which the integrity of the GI wall is lost with subsequent leakage of enteric contents into the peritoneal cavity, resulting in peritonitis. The causes of perforated viscus include trauma, bowel ischemia, infections, or ulcerative conditions, all of which ultimately lead to a full-thickness disruption of the intestinal wall. Perforated Viscus |