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 Aslam, 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][6][7][8]
| 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 following an incubation period of 5-21 days. |
| Ebola | Presents with fever, chills, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding following 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 leukocytosis distinguishes bacterial infections from viral infections. |
| Malaria | Presents with acute fever, headache, and sometimes diarrhea (in children). A blood smear 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 are helpful for distinguishing these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever. |
| Abdominal abscess (e.g., ameobic hepatic abcess) | May present with abdominal pain, fever, loss of appetite, nausea, vomiting, diarrhea, constipation. H/o surgery, presence of a mass on physical examination, ultrasound or CT scan may help rule out abdominal abscess in such cases. |
| Brucellosis | Presents with recurrent fevers, acute abdominal pain, and other symptoms resembling typhoid fever. History of exposure to infected animals, including work in a slaughterhouse or as a veterinarian, may help differentiate brucellosis from typhoid fever. |
| 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. |
| Differentiating diagnosis of Typhoid fever | Symptoms | Signs | Diagnosis | Additional Findings | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Fever | Rash | Diarrhea | Abdominal pain | Weight loss | Painful lymphadenopathy | Hepatosplenomegaly | Arthritis | Lab Findings | ||
| Brucellosis | ✔ | ✔ | ✘ | ✔ | ✔ | ✔ | ✔ | ✔ | Relative lymphocytosis | Night sweats, often with characteristic smell, likened to wet hay |
| Typhoid fever | ✔ | ✔ | ✘ | ✔ | ✘ | ✘ | ✔ | ✔ | Decreased hemoglobin | Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F) |
| Malaria | ✔ | ✘ | ✔ | ✔ | ✘ | ✘ | ✔ | ✔ | Microcytosis,
elevated LDH |
"Tertian" fever: paroxysms occur every second day |
| Tuberculosis | ✔ | ✔ | ✘ | ✔ | ✔ | ✔ | ✔ | ✔ | Mild normocytic anemia, hyponatremia, and | Night sweats, constant fatigue |
| Lymphoma | ✔ | ✘ | ✘ | ✔ | ✔ | ✘ | ✔ | ✘ | Increase ESR, increased LDH | Night sweats, constant fatigue |
| Mumps | ✔ | ✘ | ✘ | ✘ | ✘ | ✔ | ✘ | ✘ | Relative lymphocytosis, serum amylase elevated | Parotid swelling/tenderness |
| Rheumatoid arthritis | ✘ | ✔ | ✘ | ✘ | ✘ | ✘ | ✘ | ✔ | ESR and CRP elevated, positive rheumatoid factor | Morning stiffness |
| SLE | ✘ | ✔ | ✘ | ✔ | ✔ | ✘ | ✘ | ✔ | ESR and CRP elevated, positive ANA | Fatigue |
| HIV | ✘ | ✘ | ✘ | ✔ | ✔ | ✔ | ✘ | ✔ | Constant fatigue | |
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.