Typhoid fever laboratory findings
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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
Microbial culture is the gold standard tests for diagnosing typhoid fever. However, non-specific laboratory findings associated with typhoid fever include: 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
Stool culture
- Positive in 30 percent of the patients with acute typhoid fever.
- May be more effective in children.[4]
Bone marrow culture
Culture from the other sites
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
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]
| Test | Findings |
|---|---|
| Complete blood count | Decreased hemoglobin Decreased hematocrit Elevated CRP[15] |
| White blood cell count | Elevated (children) or decreased leukocyte count (adults) |
| Biochemistry | Hypoglycemia Elevated creatinine Elevated ALT, AST[16][17] Possible hyponatremia Acidosis: High lactate; Low bicarbonate (shock) |
| Coagulation | Thrombocytopenia[15] |
| Urinalysis | Proteinuria hemoglobinuria (renal failure) |
References
- ↑ 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.
- ↑ 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.
- ↑ 3.0 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.
- ↑ 4.0 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.
- ↑ 5.0 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.
- ↑ 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.
- ↑ 7.0 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.
- ↑ 8.0 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). - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ 15.0 15.1 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.
- ↑ 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.
- ↑ 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.