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{{Typhoid fever}}
{{Typhoid fever}}
{{CMG}}; {{AE}} {{JS}}; {{AA}}
{{CMG}}; {{AE}} {{JS}}, {{AAA}}


==Overview==
==Overview==
Typhoid fever must be differentiated from other diseases that cause [[fever]], [[diarrhea]], and [[dehydration]], such as [[Ebola]], [[Shigellosis]], [[Malaria]] and [[Lassa fever]].
Typhoid fever must be differentiated from other diseases that cause [[fever]], [[diarrhea]], and [[dehydration]], such as [[Ebola]], [[Shigellosis]], [[malaria]], and [[Lassa fever]].


==Differentiating Typhoid fever from other Diseases==
==Differentiating Typhoid fever from other Diseases==
The table below summarizes the findings that differentiate [[Typhoid fever]] from other conditions that cause [[fever]], [[diarrhea]], [[dehydration]] and non specific abdominal symptoms<ref> {{cite web|url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm |title=CDC Typhoid Fever |accessdate=2007-10-02 |date=2005-10-25 |publisher=Center for Disease Control }}</ref><ref name="pmid25996397">{{cite journal| author=| title=Reorganized text. | journal=JAMA Otolaryngol Head Neck Surg | year= 2015 | volume= 141 | issue= 5 | pages= 428 | pmid=25996397 | doi=10.1001/jamaoto.2015.0540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25996397  }} </ref>
The table below summarizes the findings that differentiate [[Typhoid fever]] from other conditions that cause [[fever]], [[diarrhea]], [[dehydration]], and non-specific abdominal symptoms.<ref> {{cite web|url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm |title=CDC Typhoid Fever |accessdate=2007-10-02 |date=2005-10-25 |publisher=Center for Disease Control }}</ref><ref name="pmid25996397">{{cite journal| author=| title=Reorganized text. | journal=JAMA Otolaryngol Head Neck Surg | year= 2015 | volume= 141 | issue= 5 | pages= 428 | pmid=25996397 | doi=10.1001/jamaoto.2015.0540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25996397 }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid27479027">{{cite journal| author=MacFadden DR, Bogoch II, Andrews JR| title=Advances in diagnosis, treatment, and prevention of invasive Salmonella infections. | journal=Curr Opin Infect Dis | year= 2016 | volume= 29 | issue= 5 | pages= 453-458 | pmid=27479027 | doi=10.1097/QCO.0000000000000302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479027  }} </ref><ref name="pmid19706859">{{cite journal| author=Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J et al.| title=Typhoid fever in the United States, 1999-2006. | journal=JAMA | year= 2009 | volume= 302 | issue= 8 | pages= 859-65 | pmid=19706859 | doi=10.1001/jama.2009.1229 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19706859  }} </ref><ref name="pmid27525393">{{cite journal| author=Güleşen R, Levent B, Üvey M, Bayrak H, Akgeyik M| title=[Serotype distribution and antimicrobial susceptibilities of Salmonella strains recovered from environmental samples between 2008-2014]. | journal=Mikrobiyol Bul | year= 2016 | volume= 50 | issue= 3 | pages= 371-81 | pmid=27525393 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27525393  }} </ref><ref name="pmid13207112">{{cite journal| author=SAPHRA I, WASSERMANN M| title=Salmonella cholerae suis: a clinical and epidemiological evaluation of 329 infections identified between 1940 and 1954 in the New York Salmonella Center. | journal=Am J Med Sci | year= 1954 | volume= 228 | issue= 5 | pages= 525-33 | pmid=13207112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13207112  }} </ref><ref name="pmid8291280">{{cite journal| author=Göke M, Neurath M, Braunstein S, Daniello S, Knolle P, Dippold W et al.| title=Brucellosis: differential diagnosis of acute abdominal pain. | journal=Z Gastroenterol | year= 1993 | volume= 31 | issue= 11 | pages= 671-4 | pmid=8291280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8291280 }} </ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever like syndrome]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]-like syndrome'''
| style="padding: 5px 5px; background: #F5F5F5;" | Caused by ''[[Salmonella Paratyphi]]'' A, B or C. Presents with [[fever]], [[chills]] [[vomiting]], [[abdominal pain]], generalized [[pain]] or [[malaise]],  that follow an [[incubation period]] of 5-21 days.
| style="padding: 5px 5px; background: #F5F5F5;" | Caused by ''[[Salmonella Paratyphi]]'' A, B, C or Choleraesuis. Presents with [[fever]], [[chills]], [[vomiting]], [[abdominal pain]], generalized [[pain]] or [[malaise]] following an [[incubation period]] of 5-21 days.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and sometimes [[Internal bleeding|internal]] and external [[bleeding]], that follow an [[incubation period]] of 2-21 days.
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]], [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and sometimes [[Internal bleeding|internal]] and external [[bleeding]] following an [[incubation period]] of 2-21 days.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and sometimes [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections from [[viral infections]].
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and sometimes [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leukocytosis]] distinguishes bacterial infections from [[viral infections]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and sometimes [[diarrhea]] (children). A [[blood smear]]s must be examined for malaria parasites. The presence of [[parasites]] does not exclude concurrent viral infection. An [[antimalarial]] should be prescribed as an [[empiric therapy]].
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]], and sometimes [[diarrhea]] (in children). A [[blood smear]] must be examined for malaria parasites. The presence of [[parasites]] does not exclude concurrent [[viral infection]]. An [[antimalarial]] should be prescribed as an [[empiric therapy]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
| style="padding: 5px 5px; background: #F5F5F5;" |Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
| style="padding: 5px 5px; background: #F5F5F5;" |Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation are helpful for distinguishing these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Abdominal abcess'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Abdominal abscess''' ''(e.g., ameobic hepatic abcess)''
| style="padding: 5px 5px; background: #F5F5F5;" |Such as ameobic hepatic abcess. It may present with abdominal pain, fever, loss of apatite, nausea, vomiting, diarrhea, constipation. H/o surgery, presence of a mass on physical examination, ultrasound or CT scan may help rule out abdominal abcess in such cases.   
| style="padding: 5px 5px; background: #F5F5F5;" |May present with [[abdominal pain]], [[fever]], loss of appetite, [[nausea]], [[vomiting]], [[diarrhea]], [[constipation]]. H/o surgery, presence of a mass on physical examination, ultrasound or CT scan may help rule out abdominal abscess in such cases.   
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Brucellosis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Brucellosis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with recurrent fevers, acute abdominal pain, and other symptoms resembling typhoid fever. History of exposure to infected animals like slaughter house workers, veterinarians may help differentiate it from typhoid fever.<ref name="pmid8291280">{{cite journal| author=Göke M, Neurath M, Braunstein S, Daniello S, Knolle P, Dippold W et al.| title=Brucellosis: differential diagnosis of acute abdominal pain. | journal=Z Gastroenterol | year= 1993 | volume= 31 | issue= 11 | pages= 671-4 | pmid=8291280 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8291280  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with recurrent [[fevers]], [[acute abdominal pain]], and other symptoms resembling [[typhoid fever]]. History of exposure to infected animals, including work in a slaughterhouse or as a veterinarian, may help differentiate [[brucellosis]] from [[typhoid fever]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[rheumatic fever]], [[typhus]], [[appendicitis]], [[dengue fever]],[[toxoplasmosis]], [[rickettsial diseases]], [[leishmaniasis]], [[tuberculosis]] and [[mononucleosis]] can produce [[signs]] and [[symptoms]] that may be confused with [[typhoid fever]] in the early stages of [[infection]].
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[rheumatic fever]], [[typhus]], [[appendicitis]], [[dengue fever]],[[toxoplasmosis]], [[rickettsial diseases]], [[leishmaniasis]], [[tuberculosis]], and [[mononucleosis]] can produce [[signs]] and [[symptoms]] that may be confused with [[typhoid fever]] in the early stages of [[infection]].
|}
{| class="wikitable"
!Differentiating diagnosis of Typhoid fever
! colspan="5" |Symptoms
! colspan="3" |Signs
!Diagnosis
!Additional Findings
|-
|
|Fever
|Rash
|Diarrhea
|Abdominal pain
|Weight loss
|Painful lymphadenopathy
|Hepatosplenomegaly
|Arthritis
|Lab Findings
|
|-
|[[Brucellosis]]
|✔
|✔
|✘
|✔
|✔
|✔
|✔
|✔
|[[Lymphocytosis|Relative lymphocytosis]]
|[[Night sweats]], often with characteristic smell, likened to wet hay
|-
|[[Typhoid fever]]
|✔
|✔
|✘
|✔
|✘
|✘
|✔
|✔
|Decreased [[hemoglobin]]
|Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F)
|-
|[[Malaria]]
|✔
|✘
|✔
|✔
|✘
|✘
|✔
|✔
|Microcytosis,
elevated [[LDH]]
|"Tertian" fever: paroxysms occur every second day
|-
|[[Tuberculosis]]
|✔
|✔
|✘
|✔
|✔
|✔
|✔
|✔
|Mild normocytic [[anemia]], [[hyponatremia]], and
[[hypercalcemia]]
|[[Night sweats]], constant fatigue
|-
|[[Lymphoma]]
|✔
|✘
|✘
|✔
|✔
|✘
|✔
|✘
|Increase [[ESR]], increased [[LDH]]
|[[Night sweats]], constant fatigue
|-
|[[Mumps]]
|✔
|✘
|✘
|✘
|✘
|✔
|✘
|✘
|[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]] elevated
|[[Parotid gland|Parotid]] swelling/tenderness
|-
|[[Rheumatoid arthritis]]
|✘
|✔
|✘
|✘
|✘
|✘
|✘
|✔
|[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]]
|Morning stiffness
|-
|[[SLE]]
|✘
|✔
|✘
|✔
|✔
|✘
|✘
|✔
|[[ESR]] and [[CRP]] elevated, positive [[ANA]]
|[[Fatigue]]
|-
|[[Human Immunodeficiency Virus|HIV]]
|✘
|✘
|✘
|✔
|✔
|✔
|✘
|✔
|
|Constant fatigue
|}
|}


== References ==
== References ==
{{reflist|2}}
{{reflist|2}}
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[[Category:Up-To-Date]]
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[[Category:Infectious disease]]
[[Category:Gastroenterology]]
{{WH}}
{{WS}}

Latest revision as of 02:37, 18 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Aysha Aslam, M.B.B.S[3]

Overview

Typhoid fever must be differentiated from other diseases that cause fever, diarrhea, and dehydration, such as Ebola, Shigellosis, malaria, and Lassa fever.

Differentiating Typhoid fever from other Diseases

The table below summarizes the findings that differentiate Typhoid fever from other conditions that cause fever, diarrhea, dehydration, and non-specific abdominal symptoms.[1][2][3][4][5][6][7][8]

Disease Findings
Typhoid fever-like syndrome Caused by Salmonella Paratyphi A, B, C or Choleraesuis. Presents with fever, chills, vomiting, abdominal pain, generalized pain or malaise following an incubation period of 5-21 days.
Ebola Presents with fever, chills, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding following an incubation period of 2-21 days.
Shigellosis & other bacterial enteric infections Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leukocytosis distinguishes bacterial infections from viral infections.
Malaria Presents with acute fever, headache, and sometimes diarrhea (in children). A blood smear must be examined for malaria parasites. The presence of parasites does not exclude concurrent viral infection. An antimalarial should be prescribed as an empiric therapy.
Lassa fever Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation are helpful for distinguishing these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Abdominal abscess (e.g., ameobic hepatic abcess) May present with abdominal pain, fever, loss of appetite, nausea, vomiting, diarrhea, constipation. H/o surgery, presence of a mass on physical examination, ultrasound or CT scan may help rule out abdominal abscess in such cases.
Brucellosis Presents with recurrent fevers, acute abdominal pain, and other symptoms resembling typhoid fever. History of exposure to infected animals, including work in a slaughterhouse or as a veterinarian, may help differentiate brucellosis from typhoid fever.
Others Viral hepatitis, leptospirosis, rheumatic fever, typhus, appendicitis, dengue fever,toxoplasmosis, rickettsial diseases, leishmaniasis, tuberculosis, and mononucleosis can produce signs and symptoms that may be confused with typhoid fever in the early stages of infection.
Differentiating diagnosis of Typhoid fever Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings
Brucellosis ✔ ✔ ✘ ✔ ✔ ✔ ✔ ✔ Relative lymphocytosis Night sweats, often with characteristic smell, likened to wet hay
Typhoid fever ✔ ✔ ✘ ✔ ✘ ✘ ✔ ✔ Decreased hemoglobin Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F)
Malaria ✔ ✘ ✔ ✔ ✘ ✘ ✔ ✔ Microcytosis,

elevated LDH

"Tertian" fever: paroxysms occur every second day
Tuberculosis ✔ ✔ ✘ ✔ ✔ ✔ ✔ ✔ Mild normocytic anemia, hyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Lymphoma ✔ ✘ ✘ ✔ ✔ ✘ ✔ ✘ Increase ESR, increased LDH Night sweats, constant fatigue
Mumps ✔ ✘ ✘ ✘ ✘ ✔ ✘ ✘ Relative lymphocytosis, serum amylase elevated Parotid swelling/tenderness
Rheumatoid arthritis ✘ ✔ ✘ ✘ ✘ ✘ ✘ ✔ ESR and CRP elevated, positive rheumatoid factor Morning stiffness
SLE ✘ ✔ ✘ ✔ ✔ ✘ ✘ ✔ ESR and CRP elevated, positive ANA Fatigue
HIV ✘ ✘ ✘ ✔ ✔ ✔ ✘ ✔ Constant fatigue

References

  1. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
  2. ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
  3. ↑ Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.
  4. ↑ MacFadden DR, Bogoch II, Andrews JR (2016). "Advances in diagnosis, treatment, and prevention of invasive Salmonella infections". Curr Opin Infect Dis. 29 (5): 453–458. doi:10.1097/QCO.0000000000000302. PMID 27479027.
  5. ↑ Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J; et al. (2009). "Typhoid fever in the United States, 1999-2006". JAMA. 302 (8): 859–65. doi:10.1001/jama.2009.1229. PMID 19706859.
  6. ↑ Güleşen R, Levent B, Üvey M, Bayrak H, Akgeyik M (2016). "[Serotype distribution and antimicrobial susceptibilities of Salmonella strains recovered from environmental samples between 2008-2014]". Mikrobiyol Bul. 50 (3): 371–81. PMID 27525393.
  7. ↑ SAPHRA I, WASSERMANN M (1954). "Salmonella cholerae suis: a clinical and epidemiological evaluation of 329 infections identified between 1940 and 1954 in the New York Salmonella Center". Am J Med Sci. 228 (5): 525–33. PMID 13207112.
  8. ↑ Göke M, Neurath M, Braunstein S, Daniello S, Knolle P, Dippold W; et al. (1993). "Brucellosis: differential diagnosis of acute abdominal pain". Z Gastroenterol. 31 (11): 671–4. PMID 8291280.

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