Typhoid Fever in Pakistan: XDR Typhoid Symptoms and Treatment

A fever that climbs slowly day after day, a child who will not eat, a stomach that feels heavy and sore — typhoid is a familiar illness in almost every Pakistani family. But typhoid today is not the typhoid of our parents' time. Pakistan is battling extensively drug-resistant (XDR) typhoid, and the way we test and treat it has had to change.

What is typhoid?

Typhoid fever is caused by the bacteria Salmonella Typhi, which spreads through food and water contaminated with sewage. Street food, unwashed salads, ice made from unsafe water and unboiled milk are common sources. Pakistan has one of the highest typhoid burdens in the world, and since 2016 Sindh — starting in Hyderabad and Karachi — has faced the world's first large outbreak of XDR typhoid, a strain resistant to most commonly used antibiotics. The US CDC and WHO have both flagged this strain as a global concern.

XDR does not mean untreatable. It means only a small number of antibiotics still work, so correct testing and doctor-supervised treatment matter more than ever.

Symptoms of typhoid

Typhoid usually develops gradually over one to two weeks after exposure:

• Fever that rises step by step, often higher in the evening, reaching 39 to 40 degrees
• Headache, weakness and body aches
• Poor appetite and a coated tongue
• Belly pain, constipation in adults, sometimes diarrhoea in children
• A slow pulse despite high fever, in some cases
• Occasionally faint rose-coloured spots on the chest and belly

Danger signs — go to hospital now

Untreated or partially treated typhoid can cause serious complications in the third week of illness, including intestinal bleeding or perforation. Go to an emergency department, or call Rescue 1122, if the patient has:

• Severe belly pain, a rigid or swollen abdomen
• Blood in stool or black, tar-like stool
• Confusion, extreme drowsiness or delirium
• Persistent vomiting and inability to keep fluids down
• Fever beyond 5 to 7 days that is not settling despite treatment

How doctors test for typhoid

This is where many patients in Pakistan are let down. The Widal test, still offered by many small labs, is unreliable — it can be falsely positive in people who have had typhoid or vaccination before, and falsely negative early in illness. The World Health Organization and infectious disease specialists recommend:

• Blood culture — the gold standard test, ideally taken before any antibiotics are started. It identifies the bacteria and, crucially, tells the lab which antibiotics will actually work.
• CBC — often shows a normal or low white cell count.
• Typhidot and Widal — screening tests only; a positive result should ideally be confirmed with culture.

If you can, ask your doctor for a blood culture before starting antibiotics. In XDR areas like Karachi and Hyderabad this single step can prevent weeks of failed treatment.

Treatment: why self-medication is dangerous

Typhoid is treated with antibiotics, but which antibiotic depends on the strain. XDR typhoid is resistant to the older tablets that pharmacies commonly hand out, including the fluoroquinolone and cephalosporin families in many cases. Only a few options — including certain newer oral antibiotics and injectable carbapenems for severe illness — remain reliable, and the choice must be made by a doctor, ideally guided by culture results.

Please do not buy antibiotics over the counter or stop a course early because the fever settled. Incomplete treatment breeds resistance, causes relapse, and can turn a treatable infection into a hospital admission. Alongside antibiotics, the patient needs rest, plenty of fluids, a soft and easily digestible diet, and paracetamol for fever as advised by a doctor.

Hakeem and desi treatments are a respected tradition in Pakistan, but typhoid is a bacterial infection that genuinely requires antibiotics. Herbal support for appetite or energy can sit alongside treatment, but should never replace it.

Prevention

• Drink boiled or properly filtered water; be careful with ice outside the home
• Eat freshly cooked, hot food; be cautious with street food and raw salads in outbreak season
• Wash hands with soap after the toilet and before cooking or eating
• Vaccination: Pakistan was the first country in the world to add the typhoid conjugate vaccine (TCV) to its national childhood immunisation programme, on WHO recommendation. It is given free through the EPI programme and protects for years. Adults travelling to or living in outbreak areas can ask their doctor about vaccination too.

Age-specific notes

• Children: typhoid is very common in school-age children in Pakistan. Make sure your child has received the TCV vaccine through the EPI schedule. In young children, diarrhoea and vomiting may dominate — if a small child cannot keep fluids down, read our child dehydration guide and seek care early.
• Adults: complete the full antibiotic course even after you feel better, and rest for the full recovery period — relapse is common with rushed recovery.
• Over-60s: older adults dehydrate faster and are more prone to complications; a lower threshold for hospital review is sensible.
• Pregnancy: typhoid in pregnancy needs specialist care, since both the infection and some antibiotics affect the baby. Never self-treat fever in pregnancy.

Frequently asked questions

Typhoid kitne din mein theek hota hai?

With the correct antibiotic, most people improve within 4 to 6 days of starting treatment, though full recovery and energy can take two to three weeks. If fever is not settling after 5 days of an antibiotic, go back to your doctor — the strain may be resistant to that medicine.

Is the Widal test reliable for typhoid?

Not very. Widal can be positive without active typhoid and negative in early illness. Blood culture is the reliable test, and it also tells doctors which antibiotics will work — vital in the XDR era.

Typhoid mein kya khana chahiye?

Soft, freshly cooked, easily digestible food: khichdi, yakhni, daal, boiled rice, yoghurt, bananas and plenty of fluids. Avoid heavy, oily, spicy food and anything from outside the home until fully recovered.

What is XDR typhoid and is it curable?

XDR (extensively drug-resistant) typhoid is a strain, first identified in Sindh, that resists most common antibiotics. It is still curable, but only with specific medicines chosen by a doctor, which is why culture testing and completing the full course matter so much.

Kya typhoid ki vaccine bachon ke liye zaroori hai?

Yes. WHO recommends the typhoid conjugate vaccine for children in high-burden countries, and Pakistan provides it free in the routine EPI schedule. It significantly reduces the risk of typhoid, including the XDR strain.

Worried a lingering fever could be typhoid? Start with our free symptom check to see whether you should see a doctor today. This article is general health education, not a diagnosis. Always consult a doctor about your own health.