Overview

Typhoid fever is a potentially serious bacterial disease that infects millions of people every year, especially in areas with a lack of clean water and good sanitation. The infection is due to Salmonella Typhi, transmitted by contaminated food and water and can be seriously complicated if not treated. Luckily, most people can recover fully if the condition is diagnosed in time and antibiotic therapy is administered.

The illness usually develops slowly over a period of weeks. While the symptoms and signs of typhoid fever may differ in different patients, knowing the 4 stages of typhoid fever can help patients and caregivers respond early if they see warning signs and get immediate medical care, which decreases the risk of complications.

What is Typhoid Fever?

Typhoid fever is a systemic bacterial infection caused by Salmonella enterica serotype Typhi (Salmonella Typhi). After entering the body through contaminated food or water, the bacteria multiply in the intestines before entering the bloodstream and spreading to organs such as the liver, spleen, and bone marrow.

How Does Typhoid Fever Spread?

Typhoid fever spreads mainly through the faecal-oral route, meaning the bacteria are transmitted when food or water becomes contaminated with the faeces of an infected person or carrier.

Common modes of transmission include:

Drinking contaminated or untreated water
Eating food prepared by someone with poor hand hygiene
Consuming raw fruits or vegetables washed with contaminated water
Eating undercooked food from unhygienic sources
Close contact with a person who is a chronic carrier of Salmonella Typhi

People travelling to areas where typhoid fever is common are also at an increased risk if proper food and water precautions are not followed.

Why is Early Treatment Important?

Typhoid fever requires prompt medical evaluation and treatment. Without appropriate antibiotics, the bacteria continue multiplying within the body, increasing the risk of severe illness and complications.

Early treatment helps eliminate the bacteria from the body, reduce symptom severity, lower the risk of intestinal bleeding or perforation, prevent long-term bacterial carriage, and decrease transmission to others.

Delaying treatment can lead to hospitalisation and, in severe cases, life-threatening complications.

The 4 Stages of Typhoid Fever

Although symptoms may differ among individuals, typhoid fever generally progresses through four clinical stages over approximately four weeks if left untreated.

Stage 1: Early Illness (First Week)

The illness often begins gradually rather than suddenly. During the first week, symptoms may resemble those of typical viral infections, making diagnosis difficult.

Typical symptoms include:

Slowly rising fever
Persistent headache
Fatigue and weakness
Poor appetite
Muscle aches
General body discomfort
Dry cough in some individuals
Mild abdominal discomfort
Constipation

Because symptoms are often non-specific during this stage, many people delay seeking medical care. However, early medical evaluation significantly improves treatment outcomes.

Stage 2: Established Infection (Second Week)

Without treatment, the infection becomes more severe during the second week as bacteria continue circulating throughout the body.

Symptoms may include:

Sustained high fever
Increasing abdominal pain or discomfort
Enlarged liver and spleen
Rose-coloured spots on the chest or abdomen (seen in some patients)
Severe fatigue
Loss of appetite
Abdominal bloating

Many patients experience increasing weakness during this stage, rendering daily activities difficult.

Stage 3: Severe Disease (Third Week)

The third week represents the most vital phase of untreated typhoid fever. During this period, serious complications become more likely.

Patients may experience:

Persistent high fever
Extreme weakness
Confusion nor delirium
Severe abdominal distension
Dehydration
Weight loss
Reduced consciousness in severe cases

Stage 4: Recovery Phase (Fourth Week)

During recovery:

Fever starts to subside.
Appetite gradually improves
Energy levels slowly return.
Digestive symptoms become less severe.
Weight begins to recover.

Despe feeling better, many patients continue experiencing fatigue for several weeks. Completing the full course of antibiotics and participating in follow-up appointments are necessary, as relapse can occur if treatment is incomplete.

How is Typhoid Fever Diagnosed?

Because typhoid fever shares symptoms with several other infections, laboratory investigations are necessary to confirm the diagnosis.

Blood Culture

Blood culture remains the preferred diagnostic test during the first week of illness.

It helps identify Salmonella Typhi, confirm the diagnosis, and guide appropriate antibiotic selection.

Stool and Urine Culture

These tests are particularly useful during the later stages of infection.

They help detect ongoing infection, identify chronic carriers, and confirm bacterial clearance after treatment.

Complete Blood Count (CBC)

A CBC evaluates blood cell counts and helps doctors assess the patient's overall condition while ruling out other causes of fever.

Liver Function Tests (LFTs)

Typhoid fever may affect liver function. LFTs help evaluate liver involvement and monitor disease severity.

Bone Marrow Culture

Bone marrow culture is considered the most sensitive test for diagnosing typhoid fever, especially in patients who have already started antibiotics. However, it is usually reserved for selected cases.

Polymerase Chain Reaction (PCR)

In some specialised centres, molecular tests such as PCR may help detect bacterial DNA quickly and increase diagnostic accuracy.

Widal Test

The Widal test detects antibodies produced against Salmonella Typhi. Although it may be used in areas where advanced laboratory facilities are unavailable, results should be interpreted cautiously because false-positive and false-negative results can occur. Doctors interpret Widal test findings alongside clinical symptoms and other investigations.

Treatment for Typhoid Fever

Early treatment greatly reduces complications and improves recovery. The treatment approach depends on the severity of infection, the patient's overall health, and local antibiotic resistance patterns.

Antibiotic Therapy

Antibiotics are the foundation of typhoid fever treatment. They eliminate the bacteria, shorten the duration of illness, and reduce the chance of complications.

Depending on individual circumstances, doctors may prescribe antibiotics such as ceftriaxone, azithromycin, cefixime, and other appropriate antibiotics based on culture reports and antibiotic sensitivity. Patients should complete the full prescribed course even if symptoms improve earlier.

Fluid Replacement

High fever and poor appetite can cause dehydration.

Treatment may include oral rehydration solutions, adequate water intake, and intravenous (IV) fluids for patients who cannot drink adequately or have severe dehydration.

Nutritional support

A well-balanced, easy-to-digest diet is important to aid recovery. Soft foods, fresh fruits, soups, and protein-rich foods are recommended for patients, but in moderate amounts. Until recovered, it is best to avoid spicy, oily and hard-to-digest foods.

Why choose Narayana Health?

At Narayana Health, we render comprehensive care for patients with typhoid fever, from early diagnosis to complete recovery. Our multidisciplinary team works together to secure exact diagnosis, timely treatment, and uninterrupted monitoring throughout the patient's journey.

Our services include:

Advanced laboratory facilities for blood, stool, and other diagnostic tests
Experienced infectious disease specialists and internal medicine physicians
Gastroenterologists for managing digestive complications
Critical care specialists for severe infections requiring intensive care
Personalised nutritional advice and assisting care during recovery
Coordinated multidisciplinary care for complex cases

Our patient-centred approach focuses on delivering evidence-based treatment while supporting patients and their families at every stage of recovery. Schedule a consultation with our physicians at Narayana Health today for expert guidance on diagnosing jaundice, identifying its underlying cause, and receiving a personalized treatment plan for a safe and effective recovery.

Conclusion

Typhoid fever is a serious bacterial infection that can worsen over time if left untreated. Recognising the 4 stages of typhoid fever, knowing its symptoms, and seeking medical care at the earliest signs can help prevent severe complications as well as improve treatment outcomes.

FAQs

1. What are the four stages of typhoid fever?

Typhoid fever typically progresses through four stages over several weeks if left untreated. These include an early stage with gradually rising fever, a second stage with worsening symptoms and sustained high fever, a third stage where serious complications may develop, and a recovery stage during which symptoms gradually improve with appropriate treatment.

2. How long does typhoid fever last?

With appropriate treatment, most people begin to improve within a few days, although complete recovery may take several weeks. Without treatment, the illness can persist for three to four weeks or longer.

3. Can typhoid fever be cured completely?

Yes. Most patients recover completely with timely diagnosis and the full course of prescribed antibiotics. It is important to complete treatment even if symptoms improve early.

4. Can typhoid fever come back after treatment?

Yes. A small number of patients may experience a relapse after recovery, particularly if the bacteria are not eliminated. Follow up with your doctor if symptoms return.

5. What to eat while recovering?

Eat soft, nourishing and easily digestible foods like rice, soups, cooked vegetables, fruits and protein foods (if tolerated). Stay well hydrated and refrain from junk, fried, and spicy foods until recovered.