Typhoid fever, or enteric fever, is caused by Salmonella typhi and Salmonella paratyphi. Transmission is from contaminated food or water, after contact with the infected urine or feces of symptomatic individuals, or asymptomatic carriers. After malaria is ruled out (by lack of potential exposure or by testing), typhoid fever is the most common febrile disease lasting more than 10 days in returning travelers. Incubation is 1 to 3 weeks. Symptoms include fever with headache initially, then high fever with chills, headache, cough, abdominal distention, myalgias, constipation (most common, but some have diarrhea), and prostration. A classic presentation is bradycardia relative to the height of fever, but is often absent. After several days, a pale red macular rash (“rose spots”) appears on the trunk. Complications include small bowel ulceration, anemia, disseminated intravascular coagulopathy (DIC), pneumonia, meningitis, myocarditis, and renal failure. Remarkable lab findings may include leukopenia and elevated liver enzymes, however not typical. Diagnosis is clinical, confirmation is by stool culture. After initiation of supportive care with fluids and fever control, treatment is ceftriaxone, 2 grams IV. IM for 14 days, or ciprofloxacin 500 to 750 milligrams PO twice daily for 14 days. For severe typhoid fever complicated by delirium, coma, shock, or DIC, administer dexamethasone, 3 milligrams/kilogram IV load. Blood transfusion may be required is severe cases.