Typhoid symptoms usually start 1 to 3 weeks after you swallow the bacteria. The main symptom is a fever that rises during the day and lasts more than 3 days, often climbing to 103 to 104 degrees Fahrenheit (39 to 40 degrees Celsius).
Alongside the fever, people usually feel weakness, headache, stomach pain, loss of appetite, and either constipation or diarrhoea. A rash of flat, rose-coloured spots can appear on the chest or belly.
If you have had a high fever for more than 3 days, do not self-medicate. Call a doctor on Tele-Tabeeb 1123, free, 24/7. If stomach pain becomes sudden and severe, or you see blood in stool or vomit, call 1122 immediately.
Typhoid fever is a serious infection caused by a bacteria called Salmonella Typhi. You pick it up by swallowing the bacteria, usually through contaminated food or water. Once inside, it travels from your intestines into your blood and spreads to the liver, spleen and other organs.
Doctors sometimes call it enteric fever. It is not the same as the stomach “food poisoning” people get from leftover biryani. Typhoid is a systemic illness, it makes your whole body sick, not just your stomach, and it can last for weeks if untreated.
According to the US CDC, around 9.2 million people fall ill from typhoid every year worldwide, and South Asia (including Pakistan) is one of the regions where it is most common. That is why recognising typhoid symptoms early matters so much here.
Typhoid cannot be diagnosed from symptoms alone. The gold standard is a blood culture during the first week of fever, which can grow the Salmonella Typhi bacteria. Doctors may also run a Widal test or Typhidot, along with a complete blood count.
This is why self-medicating with random antibiotics from the pharmacy is a bad idea. If the diagnosis is wrong, you waste days, build resistance, and the real infection keeps spreading.
Typhoid does not hit all at once. Symptoms usually start 1 to 3 weeks after you swallow the bacteria, sometimes as long as 6 weeks later. They build up slowly, which is what makes typhoid easy to confuse with ordinary flu or a stomach bug.
Here is the order in which symptoms usually appear, based on NHS and Mayo Clinic.
This is the number one typhoid symptom. The fever starts low in the morning and climbs through the day, hitting 103 to 104 degrees Fahrenheit (39 to 40 degrees Celsius) by evening. It usually lasts more than 3 days and does not respond fully to paracetamol.
If you or someone at home has a fever on day 4 and it is still going up each evening, that is a signal to stop guessing and get a blood test.
Alongside the fever, people feel tired, weak, and heavy-headed. Muscle aches and chills are common. Patients often say their body feels “run down” in a way that is different from a cold. Many lose their appetite and feel too drained to eat properly.
A dry cough can appear in the early days, which is one reason typhoid gets mistaken for seasonal flu. Unlike the flu, however, the fever keeps rising and the body aches get worse rather than better after a few days.
Typhoid stomach pain usually shows up after the fever and weakness are already there, NHS specifically notes this. The pain can feel dull and spread across the belly, or it can be sharper in one area.
Bowel habits change too. Adults more often get constipation (not being able to go, or going much less). Children more often get diarrhoea. Either way, it is not normal and should not be ignored.
Some patients develop a rash of small, flat, rose-coloured spots, usually on the chest or upper belly. It is easy to miss, especially on darker skin tones. If you spot a cluster of light pink spots along with a few days of fever, mention it to the doctor straight away.
If typhoid is left untreated, after a few weeks the illness can cause complications in the intestines, including a swollen belly, continued stomach pain, and sometimes confusion or hallucinations. By this stage, hospitalisation is usually needed.
Call an ambulance on 1122 immediately if the person with typhoid symptoms develops:
These are signs of intestinal bleeding or perforation (holes in the intestine), which the NHS lists as life-threatening complications of untreated typhoid.
Dial 1122 for a free SIEHS ambulance across all 30 districts of Sindh.
The CDC and Mayo Clinic both list Pakistan, India and Bangladesh among the countries with the highest typhoid rates. The reason is simple, typhoid spreads through contaminated water and food, especially in places where tap water is not reliably treated and public sanitation is uneven.
You can pick it up from:
Children are especially vulnerable. Mayo Clinic calls typhoid “a serious worldwide threat, especially to children.”
If you have ever had typhoid, there is also something important to know, a small number of people become carriers after recovery. They feel fine but keep shedding the bacteria in their stool for months or years, and can pass it on through food they prepare. If your test says you are a carrier, your doctor will prescribe a longer course of antibiotics.
Six questions families ask most often when a fever will not break and the household is worried it might be typhoid.
What are the first signs of typhoid fever?
The first sign is usually a fever that starts low in the morning and rises during the day, reaching 103 to 104 degrees Fahrenheit (39 to 40 degrees Celsius) by evening. It lasts more than 3 days and does not break fully with paracetamol. Weakness, headache, loss of appetite and a dry cough appear in the same first week. Stomach pain and bowel changes (constipation in adults, diarrhoea in children) usually come after the fever.
How long does typhoid last?
Without treatment, typhoid fever can last for weeks or even months, and the risk of serious complications keeps rising. With the right antibiotics started early, most people feel noticeably better within a week, though full recovery usually takes 2 to 4 weeks. It is important to finish the full course of antibiotics even after you feel well, because stopping early can cause the infection to come back (relapse) or make you a long-term carrier.
What organ does typhoid affect?
Typhoid is a whole-body infection. After the Salmonella Typhi bacteria enter through the gut, they travel into the blood and spread to the liver, spleen, gallbladder and lymph nodes. The most dangerous damage happens in the intestines, where untreated typhoid can cause bleeding or holes (perforation) in the intestinal wall. This is why abdominal pain in a typhoid patient should never be ignored.
Is typhoid contagious?
Yes, but not through coughing or sneezing like flu. Typhoid spreads when the bacteria from an infected person's stool get into food or water that someone else swallows, usually through unwashed hands or contaminated water. A patient should not prepare food for the family until a doctor confirms the infection has cleared. Even after recovery, a small number of people become long-term carriers and can keep spreading the bacteria for months or years.
What is the best test for typhoid?
The most accurate test is a blood culture taken during the first week of fever, which can actually grow the Salmonella Typhi bacteria. Doctors may also use the Widal test or Typhidot (antibody tests), along with a complete blood count. Do not rely on symptoms alone or start antibiotics on your own, the wrong antibiotic can mask the infection and make it harder to treat later.
Can typhoid come back after treatment?
Yes. The NHS warns that symptoms can relapse, usually within 2 weeks of finishing treatment, but sometimes much later. If a fever returns after a course of antibiotics for typhoid, go back to the doctor straight away. A second course may be needed, and in some cases further testing to check if you have become a carrier.
Typhoid is treated with antibiotics. In Pakistan, resistance to older antibiotics has become a serious problem, which is why the doctor has to pick the right one based on current local patterns and a culture report. Do not take a cousin’s leftover antibiotic from last year, it may not work and will make resistance worse.
Along with antibiotics, treatment usually includes:
Most people start to feel noticeably better within a week of starting the right antibiotic, though full recovery takes 2 to 4 weeks.
Three things cut your risk sharply:
The typhoid vaccine is also available in Pakistan, including the newer typhoid conjugate vaccine (TCV) which is part of the national immunisation programme for children. If you are travelling or live in a higher-risk area, ask your doctor about it. The vaccine does not give 100 percent protection, so safe water and food habits still matter.
If a fever has lasted more than 3 days, or stomach pain has started on top of a fever, do not wait and do not self-prescribe antibiotics. Call Tele-Tabeeb 1123, SIEHS’s free telemedicine service.
You will speak to a qualified doctor on the phone, in Urdu or English, who will listen to the symptoms and tell you whether this needs a blood test, a clinic visit, or just hydration and rest.
No credit, no appointment, no fee. Just dial 1123 from anywhere in Pakistan.
Tele-Tabeeb 1123 is available 24/7, nationwide, in Urdu and English. For emergencies in Sindh, SIEHS 1122 ambulances are also free.
Sometimes what starts as a fever and body aches is actually something else, dengue, malaria, viral hepatitis, or a seasonal flu. If you are not sure what you are dealing with, our other recent guides may help:
SIEHS runs on your support. Every donation helps keep the ambulance moving and the doctor on the line, free, for the families who need it most. You can also calculate your Zakat and give in one step.
This article is for general information and does not replace medical advice. For personalised care, speak to a qualified doctor. In an emergency, call 1122.
WhatsApp us
