Typhoid Test: What is It, When To Be Taken & Side Effects

Introduction

The typhoid infection has been increasing in India over the past few years, affecting around 10 million people in 2021¹. The infection is caused by the Salmonella typhi bacteria that enters and spreads throughout your body when you consume contaminated food or water^1,2. Some symptoms of typhoid, like fever, tiredness, and stomach pain, can resemble other diseases like malaria. Therefore, doing a typhoid test may help confirm the infection^3,4. 

In this blog, we will explain what typhoid is, which test is done for typhoid, and when to take it. 

What is Typhoid Fever?

Typhoid fever is a serious infection that spreads throughout the body after the bacteria enter the body through contaminated food or water. After the bacteria pass through the intestinal walls, they reach the blood within 24 hours. The infection then spreads to other organs like the liver, spleen, bone marrow, gall bladder, and, sometimes, into the brain. Within 7 to 14 days of exposure, symptoms like high fever, body pain, abdominal pain, and weakness start to show. If not tested and treated early, typhoid can become more severe with complications like bleeding in the stomach, perforation of the intestines, and brain-related issues like delirium, confusion, and memory loss^2,5. 

Why Typhoid Testing is Important?

The typhoid test is important to confirm that you have a typhoid infection. It helps to differentiate typhoid from other illnesses like dengue and malaria, which may have similar symptoms⁶. 

Testing in the early stage may help you take the right antibiotic and medicines, so the disease doesn’t become more severe and cause complications^6,7,8. It also may help your doctor choose the most effective antibiotic, as some bacteria in India do not respond well to certain antibiotics like fluoroquinolones².  

Testing may help find who is having typhoid, and necessary precautions can be taken to not spread it to others. In places where typhoid is prevalent, it may help to find out how many people are affected and whether it is becoming an outbreak, so that action can be taken to prevent its spread⁹.  

When Should You Get Tested for Typhoid?

Your doctor may advise you to get a typhoid test if you have^2,10: 

• A high body temperature above 38°C that rises gradually (step-wise pattern) for three or more days without a clear reason^2,10 
• Symptoms like headache, body pain, abdominal pain, constipation (seen in the early stage) and sometimes diarrhoea (occurs later). In severe cases, confusion or drowsiness may be seen^2,11,12. 
• Recent travel to typhoid-affected area or close contact with a typhoid-affected individual in the last 28 days^2,10 

In such cases, a doctor may look into your symptoms, medical history and accordingly recommend an appropriate blood test for typhoid.  

In my experience, I have noticed that unlike other fevers where pulse usually rises by 10 with every 1 degree increase in temperature, in typhoid fever, the heart beat may remain normal or slow down to less than 60 beats per minute. This relative bradycardia is classical sign seen in typhoid.

Dr. Kathak Shah, MBBS, DDV, Fellowship in Lasers & Aesthetics, Fellowship in Dermatosurgery

Who is at Higher Risk?

The risks of typhoid depend on an individual’s age, environment, and location and is higher in the following individuals^2,3,13:  

• People living in areas with unclean water and poor sanitation 
• Travellers to places where typhoid is common (areas of Africa, Asia, or Latin America) 
• Those with a weak immunity, including those with HIV/AIDS, cancer, and those taking medicines that lower their immunity (steroids or cancer medicines) 2 
• Children under 15 years of age, especially between 5 and 15 years, and those in areas where typhoid is common ^2,14 

If these individuals experience symptoms of typhoid fever, it is best to consult a doctor who may advise a blood test for typhoid. 

A with a fever lasting more than two weeks with decrease in white blood cell counts should raise the suspicion of typhoid fever. If you notice any rose coloured spots present over your chest and abdomen resembling mosquitoes/insects bites along with persistent fever, these could be signs of typhoid.

Dr. Kathak Shah, MBBS, DDV, Fellowship in Lasers & Aesthetics, Fellowship in Dermatosurgery

Types of Typhoid Tests

There is no single test that can confirm a typhoid infection. A blood culture test is considered the gold standard test for typhoid; however, different typhoid tests may help identify typhoid infection and provide more accurate results when done early. Let us see how to test for typhoid using different tests: 

1. Culture Tests

This is considered the standard test for typhoid. In this test, a sample of your blood or bone marrow is checked to find the presence of bacteria causing typhoid. It may give more reliable results compared to other tests when done in the first week of illness. It has a sensitivity of 50-80%, which means it can correctly detect the infection 5 to 8 times out of 10. Stool and urine samples can also be helpful, but they may be less reliable early on. 

2. Antibody Tests

The widal blood test for typhoid checks for antibodies which your body produces against the bacteria. It may be used commonly in areas where the disease is spreading fast. However, the results may be affected if there was any past infection or other Salmonella diseases^2,6. It usually shows positive results only after 7 to 10 days of infection, and also may miss real cases or show false positives due to low sensitivity and low specificity^2,15. 

3. Molecular Tests

The Polymerase Chain Reaction (PCR) test may help identify the genetic material (DNA) of the typhoid bacteria and show which antibiotic may work and which may not (including fluoroquinolone antibiotics). It may be more reliable compared to other tests, but it is costly and not commonly used for routine typhoid testing^2,16. 

Along with these, the doctor may advise other tests to rule out conditions like malaria and brain fever. A blood count is taken to check for a low white cell count or anaemia, and liver function tests may also be done. Together, these tests may help the doctor get a clearer picture of your disease condition and decide on how to manage it^2,6.  

Treatment and Management

Treatment of typhoid primarily involves appropriate antibiotics, based on the resistance pattern of typhoid in that region. 

Once typhoid is suspected, medication should be started as soon as possible to help prevent complications. Doing a blood culture test before starting antibiotics may help confirm the infection and guide the right choice of antibiotic for it¹⁶. However, antibiotics may also be started early based on the individual’s condition and the doctor’s judgement before test results are available, especially in areas with limited medical facilities². 

For mild cases

Oral antibiotic medicines may be given along with fever medicines like paracetamol to manage typhoid. Oral replacement fluids may help for symptoms like vomiting or diarrhoea^2,17,18. 

For severe cases

Hospital admission may be needed. Medicines like antibiotics and fluids may need to be given through the vein. 

The following antibiotics may help manage typhoid: 

• Ciprofloxacin: Can be given orally in areas with low resistance. but it may not work well in regions like India and South Asia due to widespread resistance against this antibiotic.  
• Azithromycin: In mild cases where there is resistance to ciprofloxacin^18,19. 
• Ceftriaxone: For severe cases, it is given as an injection. 
• Combination: In severe or extreme drug-resistant typhoid cases, combining antibiotics may help, for example, azithromycin with meropenem or ceftriaxone. However, this depends on the resistance pattern and blood culture results²⁰. 

Usually, the fever may reduce in 3 to 5 days after taking medicines. If not, antibiotics may need to be changed based on blood test results^2,17. 

It is important to consult a doctor to get the right plan for managing the disease based on your symptoms and clinical condition. 

Complications

Complications may develop in some patients after 2 to 3 weeks of typhoid infection. These may vary based on age, gender, existing health conditions, and the region, as follows. 

• Digestive issues: Diarrhoea, dehydration, and liver problems, especially in children. Complications like perforation in the intestines are dangerous and may need surgery. 
• Brain and nerve problems: Seizures, severe confusion (delirium), brain infections (meningitis) and other brain-related problems like altered thinking/ behaviour, trouble walking, and muscle stiffness, may be seen in some children^2,3.  
• Other health problems: Low blood count, lung infections (such as pneumonia) may occur, especially in children, people with lung diseases like cancer, or those taking medicines that lower the body’s immunity. In pregnant women, although complications are not very common, a severe infection can increase the risk of miscarriage, early delivery, or loss of the baby^2,21.  

Even after treatment, some people may carry the bacteria for weeks or months without feeling sick, but they can still spread the disease. In such cases, proper precautions should be taken to reduce the risk of spreading it to others^2,3. 

How to Prevent Typhoid?

As typhoid is mainly spread by contaminated food and water, following these practices may help reduce the risk of getting typhoid:  

• Wash your hands properly using soap and water, especially after you use the bathroom or before preparing or eating food. If soap is not available, use a hand sanitiser with at least 60% alcohol but, it may not be as effective as soap and water for typhoid prevention^22,23,24.
• Drink only boiled water or bottled water. 
• Avoid raw vegetables and fruits that you cannot peel. 
• Eat foods that are well-cooked, hot and steaming. Avoid eating foods cooked in unhygienic conditions, like food from roadside shops. 
• Drink pasteurised milk from sealed bottles. 

Vaccination against typhoid may give you added protection, especially when you are going to areas where it is more common^22,23. 

Typhoid Vaccination

Typhoid vaccination may be advised for those who travel to typhoid-affected areas, laboratory workers handling typhoid bacteria, and those who are in close contact with a typhoid case. Two vaccines that may help in such cases are: 

Inactivated (Vi polysaccharide) vaccine

This may help to develop antibodies that may fight against typhoid. It is given as an injection taken as per the doctor’s advice at least 2 weeks before travel (as protection usually starts within 7–14 days), and repeat doses every 2 years^5,26. 

Immunity is usually achieved within 7–14 days with the Vi polysaccharide vaccine, but it’s ideal to take it at least 2 weeks before exposure. 

Vi conjugate vaccine (TCV): This is a vaccine with Vi polysaccharide but joined to a special protein, which is why it is called a conjugate vaccine. It is WHO-prequalified and preferred in many countries where typhoid is common, even in India. It may give protection for up to 5 years, may work well in children under 2 years, and needs only one dose^5,27,28. 

Live attenuated (Ty21a) vaccine

It may help stimulate the immune system to act against typhoid bacteria. It can be given to people aged 6 years and older. One capsule is taken every other day (on day 1, 3, 5, and 7), for a total of 4 capsules. It should be taken at least 1 week before travel, and a booster dose may be given once in 5 years. This vaccine may not be suitable for people with weak immune systems or those taking antibiotics. 

Vaccine is not a substitute for safe hygiene practices, as it may not be 100% effective^5,25. 

What to Do While You’re Recovering from Typhoid

For quicker recovery from typhoid and to prevent spread of the disease, follow these things: 

• Take all the medicines as advised by the doctor. 
• Take adequate rest and drink plenty of water and fluids. 
• Eat easy-to-digest soft foods 
• Consult a doctor if your condition does not improve 
• Do not prepare or serve food to avoid spread of the infection 
• You may ask about vaccinating your child. 

Once you have fully recovered, you also need to monitor closely for typhoid symptoms for at least 3 months, as there is a risk of relapse or developing complications of typhoid during this period²⁹.

Also Read: Pneumococcal Vaccine: Types, Side Effects, and Who Needs It

When to See a Doctor

You need to see a doctor and may be advised to undergo a blood test for typhoid if you: 

• Have recently gone to a place where there are typhoid cases, and now have typhoid symptoms. 
• Have persistent fever for more than 3 days, severe abdominal pain, hard or swollen stomach, blood in stools/ vomiting in blood, severe weakness, confusion, or any other new symptoms. 
• Have typhoid symptoms after recovery. 
• Have been in close contact with a person with typhoid^2,30.  

Also Read: Mean Platelet Volume (MPV) Blood Test: Understanding Its Importance and Results

Conclusion

Typhoid fever can become life-threatening if not identified early with a typhoid test, and treatment is delayed. If you have persistent fever, body pain, and tiredness, especially after recent travel or close contact with a typhoid patient, you need to consult a doctor and get tested. To reduce your chances of getting typhoid, always follow safe hygiene practices for food and water during your travel and even where you stay.

Also Read: Typhoid Vaccine: What is It, Types, When to Be Taken & Side Effects

Frequently Asked Questions (FAQs)

References

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27. Syed KA, Saluja T, Cho H, Hsiao A, Shaikh H, Wartel TA, et al. Review on the Recent Advances on Typhoid Vaccine Development and Challenges Ahead. Clinical Infectious Diseases. 2020 Jul 29;71(Supplement_2):S141–50. Available from: https://academic.oup.com/cid/article/71/Supplement_2/S141/5877822 

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