Typhoid fever laboratory findings: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Aysha Aslam (talk | contribs)
nocaptcha
3,561 edits
Aysha Aslam (talk | contribs)
nocaptcha
3,561 edits
Line 50: Line 50:
===other tests===
===other tests===


Diagnosis is made by [[blood culture|blood]], [[bone marrow]] or [[stool]] cultures and with the [[Widal test]] (demonstration of salmonella [[antibody|antibodies]] against [[antigens]] O-somatic and H-flagellar). In [[epidemic]]s and less wealthy countries, after excluding [[malaria]], [[dysentery]] or [[pneumonia]], a therapeutic trial time with [[chloramphenicol]] is generally undertaken while awaiting the results of [[Widal test]] and blood cultures.<ref name=Sherris>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | isbn = 0838585299 }}</ref>
Shown below is a table summarizing nonspecific laboratory abnormalities associated with [[typhoid fever]].<ref name=CDC>{{cite web | title = tyhoid fever | url = http://www.cdc.gov/typhoid/about/disease.html }}</ref><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>
 
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
|+ '''Laboratory findings'''
|-
! style="width: 75px; background: #4479BA; text-align: center;"|{{fontcolor|#FFF|Test}}
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Findings}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Complete blood count]]'''
| style="background: #DCDCDC; padding: 5px;"| Decreased [[hemoglobin]]<br>Decreased [[hematocrit]]<br>elevated[[CRP]]<ref name="pmid24754384">{{cite journal| author=Cooper EC, Ratnam I, Mohebbi M, Leder K| title=Laboratory features of common causes of fever in returned travelers. | journal=J Travel Med | year= 2014 | volume= 21 | issue= 4 | pages= 235-9 | pmid=24754384 | doi=10.1111/jtm.12122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24754384  }} </ref>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[White blood cell count]]'''
| style="background: #DCDCDC; padding: 5px;"| Elevated (children) or decreased [[leukocyte]] count (adults)
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Biochemistry]]'''
| style="background: #DCDCDC; padding: 5px;"| [[Hypoglycemia]]<br>Elevated [[creatinine]]<br>Elevated [[ALT]],[[AST]]<ref name="pmid6703825">{{cite journal| author=Klotz SA, Jorgensen JH, Buckwold FJ, Craven PC| title=Typhoid fever. An epidemic with remarkably few clinical signs and symptoms. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 3 | pages= 533-7 | pmid=6703825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6703825  }} </ref><ref name="pmid16274504">{{cite journal| author=Wang JL, Kao JH, Tseng SP, Teng LJ, Ho SW, Hsueh PR| title=Typhoid fever and typhoid hepatitis in Taiwan. | journal=Epidemiol Infect | year= 2005 | volume= 133 | issue= 6 | pages= 1073-9 | pmid=16274504 | doi=10.1017/S0950268805004048 | pmc=2870341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16274504  }} </ref><br>Possible [[hyponatremia]]<br>Acidosis: High [[lactate]]; Low [[bicarbonate]] (shock)
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Coagulation]]'''
| style="background: #DCDCDC; padding: 5px;"| [[Thrombocytopenia]]<ref name="pmid24754384">{{cite journal| author=Cooper EC, Ratnam I, Mohebbi M, Leder K| title=Laboratory features of common causes of fever in returned travelers. | journal=J Travel Med | year= 2014 | volume= 21 | issue= 4 | pages= 235-9 | pmid=24754384 | doi=10.1111/jtm.12122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24754384  }} </ref>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Urinalysis]]'''
| style="background: #DCDCDC; padding: 5px;"| [[Proteinuria]]<br>[[hemoglobinuria]] (renal failure)
|}


== References ==
== References ==

Revision as of 15:48, 30 August 2016


Typhoid fever Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Typhoid fever from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X ray

CT

MRI

Ultrasound

Other Imaging Findings

Other diagnostic tests

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Typhoid fever laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Typhoid fever laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Typhoid fever laboratory findings

CDC on Typhoid fever laboratory findings

Typhoid fever laboratory findings in the news

Blogs on Typhoid fever laboratory findings

Directions to Hospitals Treating Typhoid fever

Risk calculators and risk factors for Typhoid fever laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Laboratory findings

Laboratory findings consistent with the diagnosis of typhoid fever include:[1][2]

Microscopic diagnosis

Culture

Cultures from the following sites may help establishing the diagnosis.[1][3][4][5][6]

Blood culture

  • Standard means of establishing the diagnosis.[4]
  • May be positive prior to the antibiotic use.[7]
  • Positive in 60 to 80 percent of the cases.

Stool culture

  • Positive in 30 percent of the patients with acute typhoid fever.
  • May be more effective in children.[4]

Bone marrow culture

  • Most sensitive.[5][8]
  • Positive in 80 to 95 percent cases.[7]

Culture from the other sites

  • Urine culture
  • Culture of the skin lesions (rose spots)[3]
  • Culture of the duodenal contents[4][8]

Molecular diagnosis

Serology

  • Widal test
  • Detection of antibodies against O and H antigen of Salmonella enterica serotype.[9]
  • Sensitivity, specificity and predictive values varies in various parts of the world.
  • A fourfold rise in antibody titre may be considered positive
  • Elisa for chronic carriers
  • Detects agglutinating antibodies against Vi antigen.
  • May help detects chronic carrier state in endemic areas.[10]
  • Newer antibopdy tests
  • Typhidot test[11]
  • May be used in areas lacking facilities for culture detection of S.typhi.[12]

PCR

  • May help detect S.typhi in culture negative patients with strong clinical suspicion.[13]

other tests

Shown below is a table summarizing nonspecific laboratory abnormalities associated with typhoid fever.[14][15]

Laboratory findings
Test Findings
Complete blood count Decreased hemoglobin
Decreased hematocrit
elevatedCRP[16]
White blood cell count Elevated (children) or decreased leukocyte count (adults)
Biochemistry Hypoglycemia
Elevated creatinine
Elevated ALT,AST[17][18]
Possible hyponatremia
Acidosis: High lactate; Low bicarbonate (shock)
Coagulation Thrombocytopenia[16]
Urinalysis Proteinuria
hemoglobinuria (renal failure)

References

  1. ↑ 1.0 1.1 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.
  2. ↑ Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM; et al. (1998). "Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance". J Clin Microbiol. 36 (6): 1683–7. PMC 104900. PMID 9620400.
  3. ↑ 3.0 3.1 Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB (1975). "Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever". Lancet. 1 (7918): 1211–3. PMID 48834.
  4. ↑ 4.0 4.1 4.2 4.3 Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E (1985). "Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children". Pediatr Infect Dis. 4 (5): 496–8. PMID 3900945.
  5. ↑ 5.0 5.1 Hoffman SL, Edman DC, Punjabi NH, Lesmana M, Cholid A, Sundah S; et al. (1986). "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". Am J Trop Med Hyg. 35 (4): 836–9. PMID 3089041.
  6. ↑ Rubin FA, McWhirter PD, Burr D, Punjabi NH, Lane E, Kumala S; et al. (1990). "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". J Clin Microbiol. 28 (4): 825–7. PMC 267809. PMID 2332479.
  7. ↑ 7.0 7.1 Gasem MH, Dolmans WM, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R (1995). "Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever". Trop Geogr Med. 47 (4): 164–7. PMID 8560588.
  8. ↑ 8.0 8.1 Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP (1984). "Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever". J Infect Dis. 149 (2): 157–61. PMID 6421940 PMID: 6421940 Check |pmid= value (help).
  9. ↑ Shukla S, Patel B, Chitnis DS (1997). "100 years of Widal test & its reappraisal in an endemic area". Indian J Med Res. 105: 53–7. PMID 9055495.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ House D, Wain J, Ho VA, Diep TS, Chinh NT, Bay PV; et al. (2001). "Serology of typhoid fever in an area of endemicity and its relevance to diagnosis". J Clin Microbiol. 39 (3): 1002–7. doi:10.1128/JCM.39.3.1002-1007.2001. PMC 87864. PMID 11230418.
  13. ↑ Song JH, Cho H, Park MY, Na DS, Moon HB, Pai CH (1993). "Detection of Salmonella typhi in the blood of patients with typhoid fever by polymerase chain reaction". J Clin Microbiol. 31 (6): 1439–43. PMC 265558. PMID 8314983.
  14. ↑ "tyhoid fever".
  15. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  16. ↑ 16.0 16.1 Cooper EC, Ratnam I, Mohebbi M, Leder K (2014). "Laboratory features of common causes of fever in returned travelers". J Travel Med. 21 (4): 235–9. doi:10.1111/jtm.12122. PMID 24754384.
  17. ↑ Klotz SA, Jorgensen JH, Buckwold FJ, Craven PC (1984). "Typhoid fever. An epidemic with remarkably few clinical signs and symptoms". Arch Intern Med. 144 (3): 533–7. PMID 6703825.
  18. ↑ Wang JL, Kao JH, Tseng SP, Teng LJ, Ho SW, Hsueh PR (2005). "Typhoid fever and typhoid hepatitis in Taiwan". Epidemiol Infect. 133 (6): 1073–9. doi:10.1017/S0950268805004048. PMC 2870341. PMID 16274504.

Template:WH

Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Typhoid_fever_laboratory_findings&oldid=1251924"