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Diagnosis of typhoid fever is based on history, physical examination, labortary findings, other diagnostic tests and imaging studies.
Diagnosis of typhoid fever is based on history, physical examination, labortary findings, other diagnostic tests and imaging studies.
===History and Symptoms===
===History and Symptoms===
Obtaining history is the most important aspect of making a diagnosis of typhoid fever
Obtaining history is the most important aspect of making a diagnosis of typhoid fever. Obtaining history is the most important aspect of making a diagnosis of typhoid fever. It provides insight into cause, risk factors, and associated comorbid conditions. Common symptoms of typhoid fever include stepledder increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F)<ref name="pmid20278487">{{cite journal| author=STUART BM, PULLEN RL| title=Typhoid; clinical analysis of 360 cases. | journal=Arch Intern Med (Chic) | year= 1946 | volume= 78 | issue= 6 | pages= 629-61 | pmid=20278487 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20278487  }} </ref>, profuse sweating, influenza-like symptoms with chills, malaise, headache<ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558  }} </ref>, poorly localised abdominal pain<ref name="pmid15673941">{{cite journal| author=Pohan HT| title=Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta. | journal=Acta Med Indones | year= 2004 | volume= 36 | issue= 2 | pages= 78-83 | pmid=15673941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15673941  }} </ref>, [[diarrhea]]<ref>Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.</ref>, [[constipation]], loss of apatite, nausea<ref name="pmid15673941">{{cite journal| author=Pohan HT| title=Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta. | journal=Acta Med Indones | year= 2004 | volume= 36 | issue= 2 | pages= 78-83 | pmid=15673941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15673941  }} </ref> and vomiting.


===Physical Examination===
===Physical Examination===

Revision as of 14:09, 6 September 2016


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Typhoid fever, also known as enteric fever and Salmonella typhi infection,[1] is an illness caused by the bacterium Salmonella enterica serovar typhi. Common worldwide, it is transmitted by the fecal-oral route — the ingestion of food or water contaminated with feces from an infected person.[2] The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste.

Historical perspective

Around 430–426 B.C., a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. A 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever.[3] Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study.[4]The most notorious carrier of typhoid fever—but by no means the most destructive—was Mary Mallon, also known as Typhoid Mary. In 1907, she became the first American carrier to be identified and traced. She was a cook in New York; some believe she was the source of infection for several hundred people. She is closely associated with forty-seven cases and three deaths.In 1897, Almroth Edward Wright developed an effective vaccine. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality.

Classification

There is no established classification system for typhoid fever. However, typhoid fever may be classified based on duration of illness, serologic type causing disease, severity of illness and virulence factors.[5]

Pathophysiology

The sequence of events in the pathogenesis of typhoid fever include innoculation, gastrointestinal infection, systemic involvement and chronic carrier state.[5][6][7][8][9][10][11][12][13][14][15]

Causes

Typhoid fever is caused by Salmonella enterica serotype Typhi (Salmonella Typhi)[16][17][18][19][20][21]. Salmonella Typhi is a gram negative bacillus, belongs to Enterobacteriaceae family, is flagellated, facultatively anaerobic and contain three important antigens O,H and Vi.[22]

Differentiating typhoid fever from other diseases

Typhoid fever must be differentiated from other diseases that cause fever, diarrhea, and dehydration, such as Ebola, Shigellosis, Malaria, Lassa fever, Brucellosis,Viral hepatitis, leptospirosis, rheumatic fever, typhus, appendicitis, dengue fever,toxoplasmosis, rickettsial diseases, leishmaniasis, tuberculosis and mononucleosis, Abdominal abcess, Yellow fever[23][24][5][25][26]

Epidemiology and Demographics

With an estimated 16-33 million cases of typhoid annually resulting in 500,000 to 600,000 deaths. In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths[27][28]. Worldwide, typhoid fever is most prevalent in areas that are overcrowded with poor hygiene and sanitation. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year. 1-6% of the individuals who are infected will develop a chronic infection in the gall bladder[29][30]. Worldwide, the incidence of typhoid fever varies in different parts of world[31][26][32]. Age, race, gender and certain environmental factors affect the distribution of disease among these groups[33][34][35].

Risk factors

Common risk factors in the development of typhoid fever are travel to endemic areas, poor hygiene habits, poor sanitation conditions, flying insects feeding on feces, contact with person recently suffered typhoid fever, recent use of antibiotics, achlorhydria, immunosuppressive illnesses such as AIDS, crowded housing, usage of raw fruits and vegetables contaminated with sewage, prolonged illness, health care workers exposed to typhoid infection, clinical microbiologists handling salmonella typhi, childhood period. [36][37][38][39][40][41]. Presence of C282 mutation and CFTR polymorphism may confer protection against typhoid fever. [42][43][44]

Screening

There are no screening guidelines for typhoid fever. However, chronic carriers can be screened using elisa detecting antibodies against Vi antigen.[45][30]

Natural history and complications

The symptoms of typhoid fever usually develop after 5 to 21 days of ingestion of causative organism. If left untreated, patient develops complications in second or third week of illness such as intestinal hemorrhage, bleeding and other life threatening illnesses.[46] Without therapy, the illness may last for 3 to 4 weeks and death rates range between 12% and 30%. Common complications of typhoid fever include intestinal perforation, intestinal hemorrhage, typhoid encephalopathy, meningitis, disseminated intravascular coagulation, miscarriage and relapse.[47][48][49][50][51][52][53][54][55][56][57] Prognosis of typhoid fever varies depending on the incidence rate. The mortality rate of typhoid fever in endemic areas is 1-4% with treatment.[28] However, the mortality rate in the areas with low incidence of typhoid fever is less than 1% with treatment.[26]

Diagnosis

Diagnosis of typhoid fever is based on history, physical examination, labortary findings, other diagnostic tests and imaging studies.

History and Symptoms

Obtaining history is the most important aspect of making a diagnosis of typhoid fever. Obtaining history is the most important aspect of making a diagnosis of typhoid fever. It provides insight into cause, risk factors, and associated comorbid conditions. Common symptoms of typhoid fever include stepledder increase in temperature initially and than sustained fever as high as 40°C (104°F)[58], profuse sweating, influenza-like symptoms with chills, malaise, headache[49], poorly localised abdominal pain[59], diarrhea[60], constipation, loss of apatite, nausea[59] and vomiting.

Physical Examination

Physical examination findings are described according to the timing of presentation. These include stepwise increase in temperature, bradycardia,[61] abdominal tenderness, hepatosplenomegaly initially. In the third week of illness patient may present with signs showing complications.[5][62]

Laboratory Findings

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CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

References

  1. ↑ Kotton C. Typhoid fever. MedlinePlus. URL: http://www.nlm.nih.gov/medlineplus/ency/article/001332.htm. Accessed on: May 4, 2007.
  2. ↑ Giannella RA (1996). "Salmonella". Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.
  3. ↑ Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E (2006). "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens". Int J Infect Dis. 10 (3): 206–14. PMID 16412683}.
  4. ↑ Shapiro B, Rambaut A, Gilbert M (2006). "No proof that typhoid caused the Plague of Athens (a reply to Papagrigorakis et al.)". Int J Infect Dis. 10 (4): 334–5, author reply 335–6. PMID 16730469.
  5. ↑ 5.0 5.1 5.2 5.3 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.
  6. ↑ McCormick BA, Miller SI, Carnes D, Madara JL (1995). "Transepithelial signaling to neutrophils by salmonellae: a novel virulence mechanism for gastroenteritis". Infect Immun. 63 (6): 2302–9. PMC 173301. PMID 7768613.
  7. ↑ Kohbata S, Yokoyama H, Yabuuchi E (1986). "Cytopathogenic effect of Salmonella typhi GIFU 10007 on M cells of murine ileal Peyer's patches in ligated ileal loops: an ultrastructural study". Microbiol Immunol. 30 (12): 1225–37. PMID 3553868.
  8. ↑ Kops SK, Lowe DK, Bement WM, West AB (1996). "Migration of Salmonella typhi through intestinal epithelial monolayers: an in vitro study". Microbiol Immunol. 40 (11): 799–811. PMID 8985935.
  9. ↑ Mills SD, Finlay BB (1994). "Comparison of Salmonella typhi and Salmonella typhimurium invasion, intracellular growth and localization in cultured human epithelial cells". Microb Pathog. 17 (6): 409–23. doi:10.1006/mpat.1994.1086. PMID 7752882.
  10. ↑ Tartera C, Metcalf ES (1993). "Osmolarity and growth phase overlap in regulation of Salmonella typhi adherence to and invasion of human intestinal cells". Infect Immun. 61 (7): 3084–9. PMC 280966. PMID 8514418.
  11. ↑ Hornick RB, Greisman SE, Woodward TE, DuPont HL, Dawkins AT, Snyder MJ (1970). "Typhoid fever: pathogenesis and immunologic control". N Engl J Med. 283 (13): 686–91. doi:10.1056/NEJM197009242831306. PMID 4916913.
  12. ↑ Fields PI, Swanson RV, Haidaris CG, Heffron F (1986). "Mutants of Salmonella typhimurium that cannot survive within the macrophage are avirulent". Proc Natl Acad Sci U S A. 83 (14): 5189–93. PMC 323916. PMID 3523484.
  13. ↑ Groisman EA, Chiao E, Lipps CJ, Heffron F (1989). "Salmonella typhimurium phoP virulence gene is a transcriptional regulator". Proc Natl Acad Sci U S A. 86 (18): 7077–81. PMC 297997. PMID 2674945.
  14. ↑ Lai CW, Chan RC, Cheng AF, Sung JY, Leung JW (1992). "Common bile duct stones: a cause of chronic salmonellosis". Am J Gastroenterol. 87 (9): 1198–9. PMID 1519582.
  15. ↑ Keuter, Monique, et al. "Patterns of proinflammatory cytokines and inhibitors during typhoid fever." Journal of Infectious Diseases 169.6 (1994): 1306-1311.
  16. ↑ Arndt MB, Mosites EM, Tian M, Forouzanfar MH, Mokhdad AH, Meller M; et al. (2014). "Estimating the burden of paratyphoid a in Asia and Africa". PLoS Negl Trop Dis. 8 (6): e2925. doi:10.1371/journal.pntd.0002925. PMC 4046978. PMID 24901439.
  17. ↑ Maskey AP, Day JN, Phung QT, Thwaites GE, Campbell JI, Zimmerman M; et al. (2006). "Salmonella enterica serovar Paratyphi A and S. enterica serovar Typhi cause indistinguishable clinical syndromes in Kathmandu, Nepal". Clin Infect Dis. 42 (9): 1247–53. doi:10.1086/503033. PMID 16586383.
  18. ↑ Oboegbulam SI, Oguike JU, Gugnani HC (1995). "Microbiological studies on cases diagnosed as typhoid/enteric fever in south-east Nigeria". J Commun Dis. 27 (2): 97–100. PMID 7499779.
  19. ↑ Vollaard AM, Ali S, Widjaja S, Asten HA, Visser LG, Surjadi C; et al. (2005). "Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia". Trans R Soc Trop Med Hyg. 99 (6): 440–50. doi:10.1016/j.trstmh.2004.09.012. PMID 15837356.
  20. ↑ Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL (2015). "Typhoid fever". Lancet. 385 (9973): 1136–45. PMID [//www.ncbi.nlm.nih.gov/pubmed/25458731 doi=10.1016/S0140-6736(13)62708-7 25458731 doi=10.1016/S0140-6736(13)62708-7] Check |pmid= value (help). line feed character in |pmid= at position 9 (help)
  21. ↑ http://www.cdc.gov/typhoid-fever/health-professional.html
  22. ↑ Fàbrega, Anna, and Jordi Vila. "Salmonella enterica serovar Typhimurium skills to succeed in the host: virulence and regulation." Clinical microbiology reviews 26.2 (2013): 308-341.
  23. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
  24. ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
  25. ↑ 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.
  26. ↑ 26.0 26.1 26.2 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.
  27. ↑ Crump, J. A., & Mintz, E. D (2010). "Global trends in typhoid and paratyphoid fever". Clinical Infectious Diseases. 50 (2): 241–246. doi:10.1086/649541. PMID 20014951.
  28. ↑ 28.0 28.1 Daul CB, deShazo RD, Andes WA, Pankey GA (1986). "Immunologic studies in homosexual and hemophiliac subjects with persistent generalized lymphadenopathy: a comparative analysis". J Allergy Clin Immunol. 77 (2): 295–301. PMID 3484760.
  29. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1093/infdis/146.6.724 Check |pmid= value (help).
  30. ↑ 30.0 30.1 Lanata CF, Levine MM, Ristori C, Black RE, Jimenez L, Salcedo M; et al. (1983). "Vi serology in detection of chronic Salmonella typhi carriers in an endemic area". Lancet. 2 (8347): 441–3. PMID 6192305.
  31. ↑ Crump JA, Luby SP, Mintz ED (2004). "The global burden of typhoid fever". Bull World Health Organ. 82 (5): 346–53. PMC 2622843. PMID 15298225.
  32. ↑ Jensenius M, Han PV, Schlagenhauf P, Schwartz E, Parola P, Castelli F; et al. (2013). "Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011". Am J Trop Med Hyg. 88 (2): 397–404. doi:10.4269/ajtmh.12-0551. PMC 3583336. PMID 23324216.
  33. ↑ "Typhoid Fever". World Health Organisation. Retrieved 2007-08-28. Check date values in: |accessdate= (help)
  34. ↑ Dewan AM, Corner R, Hashizume M, Ongee ET (2013). "Typhoid Fever and its association with environmental factors in the Dhaka Metropolitan Area of Bangladesh: a spatial and time-series approach". PLoS Negl Trop Dis. 7 (1): e1998. doi:10.1371/journal.pntd.0001998. PMC 3554574. PMID 23359825.
  35. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0140-6736(98)09 Check |pmid= value (help).
  36. ↑ Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA; et al. (1998). "Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan". Epidemiol Infect. 120 (2): 129–38. PMC 2809381. PMID 9593481.
  37. ↑ Marshall E, Howells RE (1986). "Turnover of the surface proteins of adult and third and fourth stage larval Brugia pahangi". Mol Biochem Parasitol. 18 (1): 17–24. PMID 2870432.
  38. ↑ Srikantiah P, Vafokulov S, Luby SP, Ishmail T, Earhart K, Khodjaev N; et al. (2007). "Epidemiology and risk factors for endemic typhoid fever in Uzbekistan". Trop Med Int Health. 12 (7): 838–47. doi:10.1111/j.1365-3156.2007.01853.x. PMID 17596250.
  39. ↑ Mermin, Jonathan H., et al. "A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water." Journal of Infectious Diseases 179.6 (1999): 1416-1422.
  40. ↑ Black, Robert E., et al. "Case—control study to identify risk factors for paediatric endemic typhoid fever in Santiago, Chile." Bulletin of the World Health Organization 63.5 (1985): 899.
  41. ↑ Parry CM, Thompson C, Vinh H, Chinh NT, Phuong le T, Ho VA; et al. (2014). "Risk factors for the development of severe typhoid fever in Vietnam". BMC Infect Dis. 14: 73. doi:10.1186/1471-2334-14-73. PMC 3923984. PMID 24512443.
  42. ↑ Weinberg ED (2008). "Survival advantage of the hemochromatosis C282Y mutation". Perspect Biol Med. 51 (1): 98–102. doi:10.1353/pbm.2008.0001. PMID 18192769.
  43. ↑ Moalem S, Weinberg ED, Percy ME (2004). "Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival". Biometals. 17 (2): 135–9. PMID 15088940.
  44. ↑ van de Vosse E, de Visser AW, Al-Attar S, Vossen R, Ali S, van Dissel JT (2010). "Distribution of CFTR variations in an Indonesian enteric fever cohort". Clin Infect Dis. 50 (9): 1231–7. doi:10.1086/651598. PMID 20233062.
  45. ↑ http://www.uspreventiveservicestaskforce.org/
  46. ↑ Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD; et al. (2012). "A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009". Clin Infect Dis. 54 (8): 1091–9. doi:10.1093/cid/cis025. PMID 22357703.
  47. ↑ Bitar, Roger, and John Tarpley. "Intestinal perforation in typhoid fever: a historical and state-of-the-art review." Review of Infectious Diseases 7.2 (1985): 257-271.
  48. ↑ van Basten JP, Stockenbrügger R (1994). "Typhoid perforation. A review of the literature since 1960". Trop Geogr Med. 46 (6): 336–9. PMID 7892698.
  49. ↑ 49.0 49.1 Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR; et al. (1984). "Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone". N Engl J Med. 310 (2): 82–8. doi:10.1056/NEJM198401123100203. PMID 6361558.
  50. ↑ Punjabi NH, Hoffman SL, Edman DC, Sukri N, Laughlin LW, Pulungsih SP; et al. (1988). "Treatment of severe typhoid fever in children with high dose dexamethasone". Pediatr Infect Dis J. 7 (8): 598–600. PMID 3050856.
  51. ↑ Seoud M, Saade G, Uwaydah M, Azoury R (1988). "Typhoid fever in pregnancy". Obstet Gynecol. 71 (5): 711–4. PMID 3357660.
  52. ↑ Reed RP, Klugman KP (1994). "Neonatal typhoid fever". Pediatr Infect Dis J. 13 (9): 774–7. PMID 7808844.
  53. ↑ Wain J, Hien TT, Connerton P, Ali T, Parry CM, Chinh NT; et al. (1999). "Molecular typing of multiple-antibiotic-resistant Salmonella enterica serovar Typhi from Vietnam: application to acute and relapse cases of typhoid fever". J Clin Microbiol. 37 (8): 2466–72. PMC 85257. PMID 10405386.
  54. ↑ Levine, Myron M., Robert E. Black, and Claudio Lanata. "Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area." Journal of Infectious Diseases 146.6 (1982): 724-726.
  55. ↑ Gupta SP, Gupta MS, Bhardwaj S, Chugh TD (1985). "Current clinical patterns of typhoid fever: a prospective study". J Trop Med Hyg. 88 (6): 377–81. PMID 3837121.
  56. ↑ Huang DB, DuPont HL (2005). "Problem pathogens: extra-intestinal complications of Salmonella enterica serotype Typhi infection". Lancet Infect Dis. 5 (6): 341–8. doi:10.1016/S1473-3099(05)70138-9. PMID 15919620.
  57. ↑ Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS; et al. (2012). "Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border". Clin Infect Dis. 54 (8): 1100–6. doi:10.1093/cid/cis012. PMID 22357702.
  58. ↑ STUART BM, PULLEN RL (1946). "Typhoid; clinical analysis of 360 cases". Arch Intern Med (Chic). 78 (6): 629–61. PMID 20278487.
  59. ↑ 59.0 59.1 Pohan HT (2004). "Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta". Acta Med Indones. 36 (2): 78–83. PMID 15673941.
  60. ↑ Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.
  61. ↑ Ostergaard L, Huniche B, Andersen PL (1996). "Relative bradycardia in infectious diseases". J Infect. 33 (3): 185–91. PMID 8945708.
  62. ↑ Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA (2015). "Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever". J Glob Health. 5 (2): 020407. doi:10.7189/jogh.05.020407. PMC 4672836. PMID 26649174.

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