Typhoid fever - Complications of typhoid fever

Complications caused by typhoid fever usually only occur in people who have not been treated with appropriate antibiotics, or who have had delayed treatment.

In such cases, about 1 in 10 people experience complications, which usually develop during the third week of infection.

The two most common complications in untreated typhoid fever are:

internal bleeding in the digestive system
splitting (perforation) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

These are described in more detail below.

Internal bleeding

Most internal bleeding that occurs in typhoid fever is not life threatening, but can make you feel very unwell.

Symptoms include:

feeling tired all the time
breathlessness
pale skin
irregular heartbeat
vomiting blood
passing stools that are very dark or tar-like

A blood transfusion may be required to replace lost blood, and surgery can be used to repair the site of the bleeding.

Perforation

Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.

Peritonitis is a medical emergency, as the tissue of the peritoneum is usually sterile and germ-free. Unlike other parts of the body, such as the skin, the peritoneum does not have an inbuilt defence mechanism for fighting infection.

In cases of peritonitis, an infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure. If it is not treated aggressively, it may result in death. The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.

Peritonitis requires admission to hospital, where you will be treated with injections of antibiotics. Surgery will then be used to seal the hole in your intestinal wall.