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Typhoid Fever in Nigeria

Understanding, treating, and preventing typhoid in Lagos.

Typhoid fever is caused by Salmonella typhi, spread through contaminated food and water. It remains endemic in Nigeria, with Lagos bearing a significant burden due to water supply challenges and food hygiene. Proper diagnosis, the right antibiotic, and completion of the full course are essential — and vaccination is available.

Signs and Symptoms

✓ Sustained high fever — often 39–40°C, rising over the first week
✓ Severe headache
✓ Abdominal pain — often diffuse
✓ Loss of appetite
✓ Constipation (early) or diarrhoea (later)
✓ Relative bradycardia — pulse rate lower than expected for the fever degree
✓ Rose spots — faint pink spots on the trunk (difficult to see on dark skin)
✓ Confusion or delirium ("typhoid state") in severe or untreated cases
✓ Intestinal bleeding or perforation — life-threatening complication

Risk Factors

When to Seek Help

NowHigh fever with confusion, severe abdominal pain, significant rectal bleeding, or inability to keep fluids down — possible intestinal perforation or severe typhoid; emergency hospital admission needed.
SoonHigh fever lasting more than 3 days, especially with headache and abdominal symptoms — must test for typhoid and start appropriate treatment.
RoutineTyphoid vaccination for high-risk individuals or before travel.

Tests & Diagnosis

🧪 Blood Culture
The gold standard for typhoid diagnosis — 80–90% sensitive in the first week. Blood is taken before antibiotics and cultured for Salmonella typhi. Takes 3–7 days for a result.
🧪 Widal Test
Widely used but unreliable — many false positives and false negatives in Nigeria. Should not be used alone to diagnose typhoid. See our Widal test explainer page for full details.
🧪 Typhoid Rapid Test (Typhidot)
Detects antibodies to typhoid — faster than culture but less specific. Better than Widal but still inferior to blood culture.
🧪 Full Blood Count
Leucopenia (low white cell count) is typical in typhoid — helps distinguish from bacterial infections where white cells are elevated.
🧪 Liver Function Tests
Hepatitis is common in typhoid — elevated liver enzymes are frequently found.

Treatment Options

1
Ceftriaxone — Preferred Hospital Treatment
Intravenous ceftriaxone for severe typhoid — highly effective against most Salmonella typhi strains in Nigeria. Typically 10–14 days.
2
Azithromycin — Oral Outpatient Treatment
Oral azithromycin for uncomplicated typhoid — excellent efficacy, well tolerated, and active against many resistant strains. 5–7 days.
3
Fluoroquinolones (Ciprofloxacin)
Previously first-line but increasing resistance in Nigeria — now used only when susceptibility is confirmed. Do not use empirically without culture.
4
Avoid Chloramphenicol and Ampicillin
Widespread resistance in Nigeria makes these older agents unreliable. Still used in some settings but with high treatment failure risk.
5
Supportive Care
Adequate hydration, fever management (paracetamol), nutrition. Isolation and careful hygiene (hand washing, separate utensils) to prevent household spread.

Frequently Asked Questions

Is the Widal test reliable for typhoid?
No — the Widal test has poor specificity in Nigeria where many people have had previous typhoid infections or vaccination, leading to falsely elevated antibody levels. A positive Widal alone should not be the basis for a typhoid diagnosis. Blood culture or Typhidot are more reliable.
Can I get typhoid more than once?
Yes — having typhoid once does not confer permanent immunity. The vaccine provides protection for several years but needs to be repeated.
What is a typhoid carrier?
Some people who recover from typhoid continue to shed Salmonella typhi in their stool for more than a year (chronic carriers) without symptoms. They can infect others. Carriers should not work as food handlers and may need prolonged antibiotic treatment.
What prevents typhoid?
Clean, properly treated water (boiling, purification), careful food hygiene (avoid uncooked foods, peeled fruits, street food from unhygienic sources), hand washing after toilet use and before eating, and typhoid vaccination.
How long does typhoid treatment take?
Typically 7–14 days of antibiotics depending on severity and antibiotic choice. Feeling better does not mean the infection is eradicated — complete the full course to prevent relapse and chronic carriage.

Related Pages

Typhoid vs MalariaWidal Test ExplainedWhy Finish Antibiotics

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