What Are Rose Spots?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 15 September 2019
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Rose spots are a rash associated with acute typhoid infection. Commonly known as typhoid fever, the infection is caused by exposure to Salmonella Typhi bacteria. Highly contagious, the infection is most often found in unclean water and, subsequently, food supplies tainted by the contaminated water. If treated in a timely and appropriate manner, most people with typhoid fever make a full recovery. When left untreated, typhoid fever can lead to serious complications, including organ failure and death.

Rose-colored spots, which may range from light pink to reddish-pink in color, vary in size and usually develop within the first week of typhoid infection. Generally, rose spots remain localized to the lower abdomen and upper legs. Fever, abdominal discomfort and fatigue generally accompany rose spots. As infection worsens, individuals may develop sore throat and diarrhea. It is not uncommon for a severe infection to induce hallucinations, confusion and delirium in some people.

Despite its namesake, Salmonella Typhi is not responsible for other forms of enteric, or intestinal, fever. Unsanitary conditions, as may be found in developing countries, offer the perfect environment for the bacteria to thrive. Insufficient sanitation and improper hygiene perpetuate the spread of the bacteria. Individuals who travel to locations where typhoid fever is known to exist are considered at greatest risk for rose spots and infection.


Once Salmonella Typhi is introduced into the body, it travels to the intestine where it burrows into the intestinal lining. In the absence of treatment, the bacterium spreads to other parts of the body where it reproduces and is eventually expelled, in part, in feces. Depending on the severity of infection, the individual may demonstrate mild infection, known as paratyphoid fever, or more serious signs associated with typhoid fever.

A diagnosis of typhoid fever is generally made based on the presentation of symptoms. Since rose spots are one of the first signs, a diagnosis may be made prior to diagnostic testing. To confirm a diagnosis, a culture of the individual’s stool is usually taken. Additional testing can include a blood draw to evaluate the extent of Salmonella Typhi bacteria present. A high white blood cell count, which occurs in the presence of infection, and low blood platelets are markers associated with typhoid fever.

Antibiotic therapy is the first course of treatment for rose spots and typhoid fever. Typhoid fever has adapted over the years and there are now strains that prove resistant to some antibiotics. Therefore, identification of the bacterial strain from a culture is essential to ensure the right antibiotic is prescribed. Intravenous fluids, including electrolytes, are also given to treat and prevent further dehydration. Considering typhoid may be spread through interpersonal contact, hospitalization is often required until antibiotic treatment has been established and symptoms are alleviated.

Delayed or absent treatment for typhoid fever can result in life-threatening complications. Of the most common complications is intestinal perforation, which occurs when intestinal tissue becomes weakened by the effects of Salmonella Typhi and splits or tears. If intestinal perforation occurs, the individual is at risk for sepsis, or blood infection, due to the introduction of bacteria into the blood stream. Ultimately, organ function becomes significantly impaired and may lead to organ failure and death.


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