Typhoid fever, also known simply as typhoid, is a bacterial infection due to Salmonella typhi that causes symptoms. Symptoms may vary from mild to severe and usually begin six to thirty days after exposure. Often there is a gradual onset of a high feverover several days. Weakness, abdominal pain, constipation, and headaches also commonly occur. Diarrhea is uncommon and vomiting is not usually severe. Some people develop a skin rash with rose colored spots. In severe cases there may be confusion. Without treatment symptoms may last weeks or months. Other people may carry the bacterium without being affected; however, they are still able to spread the disease to others. Typhoid fever is a type of enteric fever along withparatyphoid fever. The cause is the bacterium Salmonella typhi, also known as Salmonella enterica serotype typhi, growing in the intestines andblood. Typhoid is spread by eating or drinking food or water contaminated with the feces of an infected person. Risk factors include poor sanitation and poor hygiene. Those who travel to the developing world are also at risk. Humans are the only animal infected. Diagnosis is by either culturing the bacteria or detecting the bacterium’s DNA in the blood, stool, or bone marrow.Culturing the bacterium can be difficult. Bone marrow testing is the most accurate. Symptoms are similar to that of many other infectious diseases. Typhus is a different disease. A typhoid vaccine can prevent about 30% to 70% of cases during the first two years. The vaccine may have some effect for up to seven years. It is recommended for those at high risk or people traveling to areas where the disease is common. Other efforts to prevent the disease include providing clean drinking water, better sanitation, and better handwashing. Until it has been confirmed that an individual’s infection is cleared, the individual should not prepare food for others. Treatment of disease is withantibiotics such as azithromycin, fluoroquinolones or third generation cephalosporins. Resistance to these antibiotics has been developing, which has made treatment of the disease more difficult. In 2010 there were 27 million cases reported. The disease is most common in India, and children are most commonly affected. Rates of disease decreased in thedeveloped world in the 1940s as a result of improved sanitation and use of antibiotics to treat the disease. About 400 cases are reported and the disease is estimated to occur in about 6,000 people per year in the United States. In 2013 it resulted in about 161,000 deaths – down from 181,000 in 1990 (about 0.3% of the global total). The risk of death may be as high as 25% without treatment, while with treatment it is between 1 and 4%. The name typhoid means “resembling typhus” due to the similarity in symptoms.