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| ==Laboratory findings== | | ==Laboratory findings== |
| Microbial culture is the gold standard tests for [[Typhoid fever other diagnostic studies|diagnosing typhoid fever]]. However, non-specific laboratory findings associated with typhoid fever include: | | Microbial culture is the gold standard test for [[Typhoid fever other diagnostic studies|diagnosing typhoid fever]]. However, non-specific laboratory findings associated with typhoid fever include:<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="pmid9620400">{{cite journal| author=Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM et al.| title=Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 6 | pages= 1683-7 | pmid=9620400 | doi= | pmc=104900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9620400 }} </ref> |
| Laboratory findings consistent with the diagnosis of typhoid fever include:<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="pmid9620400">{{cite journal| author=Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM et al.| title=Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 6 | pages= 1683-7 | pmid=9620400 | doi= | pmc=104900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9620400 }} </ref>
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| ===Microscopic diagnosis===
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| ====Culture====
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| Cultures from the following sites may help establishing the diagnosis.<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="pmid48834">{{cite journal| author=Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB| title=Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. | journal=Lancet | year= 1975 | volume= 1 | issue= 7918 | pages= 1211-3 | pmid=48834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=48834 }} </ref><ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945 }} </ref><ref name="pmid3089041">{{cite journal| author=Hoffman SL, Edman DC, Punjabi NH, Lesmana M, Cholid A, Sundah S et al.| title=Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml 1:10 blood-to-broth ratio blood culture for diagnosis of typhoid fever. | journal=Am J Trop Med Hyg | year= 1986 | volume= 35 | issue= 4 | pages= 836-9 | pmid=3089041 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3089041 }} </ref><ref name="pmid2332479">{{cite journal| author=Rubin FA, McWhirter PD, Burr D, Punjabi NH, Lane E, Kumala S et al.| title=Rapid diagnosis of typhoid fever through identification of Salmonella typhi within 18 hours of specimen acquisition by culture of the mononuclear cell-platelet fraction of blood. | journal=J Clin Microbiol | year= 1990 | volume= 28 | issue= 4 | pages= 825-7 | pmid=2332479 | doi= | pmc=267809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2332479 }} </ref>
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| '''Blood culture'''
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| :*Standard means of establishing the diagnosis.<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945 }} </ref>
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| :*May be positive prior to the antibiotic use.<ref name="pmid8560588">{{cite journal| author=Gasem MH, Dolmans WM, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R| title=Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever. | journal=Trop Geogr Med | year= 1995 | volume= 47 | issue= 4 | pages= 164-7 | pmid=8560588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8560588 }} </ref>
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| :*Positive in 60 to 80 percent of the cases.
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| '''Stool culture'''
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| :*Positive in 30 percent of the patients with acute typhoid fever.
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| :*May be more effective in children.<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945 }} </ref>
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| '''Bone marrow culture'''
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| :*Most sensitive.<ref name="pmid3089041">{{cite journal| author=Hoffman SL, Edman DC, Punjabi NH, Lesmana M, Cholid A, Sundah S et al.| title=Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml 1:10 blood-to-broth ratio blood culture for diagnosis of typhoid fever. | journal=Am J Trop Med Hyg | year= 1986 | volume= 35 | issue= 4 | pages= 836-9 | pmid=3089041 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3089041 }} </ref><ref name="pmidPMID: 6421940">{{cite journal| author=Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP| title=Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 2 | pages= 157-61 | pmid=PMID: 6421940 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6421940 }} </ref>
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| :*Positive in 80 to 95 percent cases.<ref name="pmid8560588">{{cite journal| author=Gasem MH, Dolmans WM, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R| title=Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever. | journal=Trop Geogr Med | year= 1995 | volume= 47 | issue= 4 | pages= 164-7 | pmid=8560588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8560588 }} </ref>
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| '''Culture from the other sites'''
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| :*Urine culture
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| :*Culture of the skin lesions (rose spots)<ref name="pmid48834">{{cite journal| author=Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB| title=Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. | journal=Lancet | year= 1975 | volume= 1 | issue= 7918 | pages= 1211-3 | pmid=48834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=48834 }} </ref>
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| :*Culture of the duodenal contents<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945 }} </ref><ref name="pmidPMID: 6421940">{{cite journal| author=Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP| title=Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 2 | pages= 157-61 | pmid=PMID: 6421940 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6421940 }} </ref>
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| ===Molecular diagnosis===
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| ====Serology====
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| *'''Widal test'''
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| ::*Detection of antibodies against O and H antigen of ''[[Salmonella enterica]]'' serotype.<ref name="pmid9055495">{{cite journal| author=Shukla S, Patel B, Chitnis DS| title=100 years of Widal test & its reappraisal in an endemic area. | journal=Indian J Med Res | year= 1997 | volume= 105 | issue= | pages= 53-7 | pmid=9055495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9055495 }} </ref>
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| ::*Sensitivity, specificity and predictive values varies in various parts of the world.
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| ::*A fourfold rise in antibody titre may be considered positive
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| *'''Elisa for chronic carriers'''
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| ::*Detects agglutinating antibodies against Vi antigen.
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| ::*May help detects chronic carrier state in endemic areas.<ref name="pmid6192305">{{cite journal| author=Lanata CF, Levine MM, Ristori C, Black RE, Jimenez L, Salcedo M et al.| title=Vi serology in detection of chronic Salmonella typhi carriers in an endemic area. | journal=Lancet | year= 1983 | volume= 2 | issue= 8347 | pages= 441-3 | pmid=6192305 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6192305 }} </ref>
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| *'''Newer antibopdy tests'''
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| ::*Typhidot test<ref> Bhutta, Zulfiqar Ahmed, and Naseem Mansurali. "Rapid serologic diagnosis of pediatric typhoid fever in an endemic area: a prospective comparative evaluation of two dot-enzyme immunoassays and the Widal test." The American journal of tropical medicine and hygiene 61.4 (1999): 654-657.</ref>
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| ::*May be used in areas lacking facilities for culture detection of S.typhi.<ref name="pmid11230418">{{cite journal| author=House D, Wain J, Ho VA, Diep TS, Chinh NT, Bay PV et al.| title=Serology of typhoid fever in an area of endemicity and its relevance to diagnosis. | journal=J Clin Microbiol | year= 2001 | volume= 39 | issue= 3 | pages= 1002-7 | pmid=11230418 | doi=10.1128/JCM.39.3.1002-1007.2001 | pmc=87864 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11230418 }} </ref>
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| ====PCR====
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| ::*May help detect S.typhi in culture negative patients with strong clinical suspicion.<ref name="pmid8314983">{{cite journal| author=Song JH, Cho H, Park MY, Na DS, Moon HB, Pai CH| title=Detection of Salmonella typhi in the blood of patients with typhoid fever by polymerase chain reaction. | journal=J Clin Microbiol | year= 1993 | volume= 31 | issue= 6 | pages= 1439-43 | pmid=8314983 | doi= | pmc=265558 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8314983 }} </ref>
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| ===other tests===
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| Shown below is a table summarizing nonspecific laboratory abnormalities associated with [[typhoid fever]].<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> | | Shown below is a table summarizing nonspecific laboratory abnormalities associated with [[typhoid fever]].<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> |
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