Typhoid fever differential diagnosis
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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 Anwar, 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]
| 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, that follow an incubation period of 5-21 days.[6][7] |
| Ebola | Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding, that follow 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 leucocytosis distinguishes bacterial infections from viral infections. |
| Malaria | Presents with acute fever, headache and sometimes diarrhea (children). A blood smears 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 serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever. |
| Abdominal abcess | 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. |
| Brucellosis | 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.[8] |
| 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. |
References
- ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
- ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.