For how many days does fever present in enteric (typhoid) fever?

Duration of Fever in Enteric (Typhoid) Fever

Fever in enteric fever typically persists for 7-21 days if left untreated, with gradual onset over 3-7 days, but resolves within 4-5 days with appropriate antibiotic therapy. 1, 2

Untreated Disease Course

• The natural course of untreated enteric fever involves fever lasting 7-21 days from the time of symptom onset 2
• Fever develops gradually over 3-7 days, accompanied by malaise, headache, and myalgia 1, 3
• Life-threatening complications typically arise in the second week of untreated illness, including intestinal perforation and encephalopathy, which occur in 10-15% of patients with illness duration exceeding 2 weeks 1, 4, 5

Treated Disease Course

• With appropriate antibiotic therapy, fever clearance occurs within 4-5 days 5, 4
• Fluoroquinolones (when the organism is sensitive) achieve the fastest fever clearance time of less than 4 days 4
• Azithromycin demonstrates hospital stays approximately 1 day shorter compared to fluoroquinolones 5, 6

Clinical Implications for Diagnosis

• Blood cultures have the highest diagnostic yield (up to 80% sensitivity) within the first week of symptom onset 4, 3, 5
• The relatively long incubation period of 7-18 days (range 3-60 days) means most travelers develop symptoms after returning home 4, 3
• Stool and urine cultures become positive only after the first week of illness 4

Treatment Duration to Prevent Relapse

• Complete the full 14-day antibiotic course to reduce relapse risk, even if fever resolves early 4, 5
• Relapse rates with adequate treatment are less than 8% for ceftriaxone and less than 3% for azithromycin 4, 5
• Inadequate treatment duration leads to relapse in 10-15% of cases 5

Key Clinical Pitfall

• If fever persists beyond 48 hours of appropriate antibiotic therapy in a clinically stable patient, reassess for alternative diagnoses or complications rather than changing antibiotics empirically 4
• Persistent fever beyond 3 days despite empirical therapy should prompt thorough search for breakthrough infections or complications 4