Typhoid germs are passed in the feces and, to some extent, the urine of infected people. The germs are spread by eating or drinking water or foods contaminated by feces from the infected individual. Symptoms may be mild or severe and may include fever, headache, constipation or diarrhea, rose-colored spots on the trunk and an enlarged spleen and liver. Relapses are common. Fatalities are less than 1 percent with antibiotic treatment.
Symptoms generally appear one to three weeks after exposure.
The carrier stage varies from a number of days to years. Only about 3 percent of cases go on to become lifelong carriers of the germ and this tends to occur more often in adults than in children. Specific antibiotics such as chloramphenicol, ampicillin or amoxicillin are often used to treat cases of typhoid. Most infected people may return to work or school when they have recovered, provided that they carefully wash hands after toilet visits. Children in day care and other sensitive settings must obtain the approval of the local or state health department before returning to their routine activities.