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{{Typhoid fever}}
{{Typhoid fever}}
 
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== Overview ==
== Overview ==
Nonspecific laboratory abnormalities associated with [[typhoid fever]] include decreased [[hemoglobin]], decreased or increased [[leukocyte]] count, elevated [[CRP]], and abnormal [[liver function tests]].<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><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid9620400">{{cite journal| author=Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM et al.| title=Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 6 | pages= 1683-7 | pmid=9620400 | doi= | pmc=104900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9620400  }} </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><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>


==Laboratory findings==
==Laboratory findings==
Laboratory findings consistent with the diagnosis of typhoid fever include:<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid9620400">{{cite journal| author=Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM et al.| title=Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 6 | pages= 1683-7 | pmid=9620400 | doi= | pmc=104900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9620400  }} </ref>
[[Microbial culture]] is the gold standard test for the diagnosis of [[typhoid fever]].<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid9620400">{{cite journal| author=Wain J, Diep TS, Ho VA, Walsh AM, Nguyen TT, Parry CM et al.| title=Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. | journal=J Clin Microbiol | year= 1998 | volume= 36 | issue= 6 | pages= 1683-7 | pmid=9620400 | doi= | pmc=104900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9620400  }} </ref> Shown below is a table summarizing nonspecific laboratory abnormalities associated with [[typhoid fever]].<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><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><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>
===Culture===
Cultures from the following sites may help establishing diagnosis<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid48834">{{cite journal| author=Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB| title=Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. | journal=Lancet | year= 1975 | volume= 1 | issue= 7918 | pages= 1211-3 | pmid=48834 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=48834  }} </ref><ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945  }} </ref><ref name="pmid3089041">{{cite journal| author=Hoffman SL, Edman DC, Punjabi NH, Lesmana M, Cholid A, Sundah S et al.| title=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. | journal=Am J Trop Med Hyg | year= 1986 | volume= 35 | issue= 4 | pages= 836-9 | pmid=3089041 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3089041  }} </ref><ref name="pmid2332479">{{cite journal| author=Rubin FA, McWhirter PD, Burr D, Punjabi NH, Lane E, Kumala S et al.| title=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. | journal=J Clin Microbiol | year= 1990 | volume= 28 | issue= 4 | pages= 825-7 | pmid=2332479 | doi= | pmc=267809 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2332479 }} </ref>
 
'''Blood culture'''
:*Standard means of establishing diagnosis.<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945  }} </ref>
:*May be positive prior to antibiotic use.<ref name="pmid8560588">{{cite journal| author=Gasem MH, Dolmans WM, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R| title=Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever. | journal=Trop Geogr Med | year= 1995 | volume= 47 | issue= 4 | pages= 164-7 | pmid=8560588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8560588  }} </ref>
:*Positive in 60 to 80 percent of cases.
'''Stool culture'''
:*Positive in 30 percent of patients with acute typhoid fever
:*May be more effective in children<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945  }} </ref>
'''Bone marrow culture'''
:*Most sensitive<ref name="pmid3089041">{{cite journal| author=Hoffman SL, Edman DC, Punjabi NH, Lesmana M, Cholid A, Sundah S et al.| title=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. | journal=Am J Trop Med Hyg | year= 1986 | volume= 35 | issue= 4 | pages= 836-9 | pmid=3089041 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3089041  }} </ref><ref name="pmidPMID:    6421940">{{cite journal| author=Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP| title=Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 2 | pages= 157-61 | pmid=PMID:    6421940 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6421940  }} </ref>
:*Positive in 80 to 95 percent cases<ref name="pmid8560588">{{cite journal| author=Gasem MH, Dolmans WM, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R| title=Culture of Salmonella typhi and Salmonella paratyphi from blood and bone marrow in suspected typhoid fever. | journal=Trop Geogr Med | year= 1995 | volume= 47 | issue= 4 | pages= 164-7 | pmid=8560588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8560588  }} </ref>
'''Culture from other sites'''
:*Urine culture
:*Culture of skin lesions
:*Culture of duodenal contents<ref name="pmid3900945">{{cite journal| author=Vallenas C, Hernandez H, Kay B, Black R, Gotuzzo E| title=Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children. | journal=Pediatr Infect Dis | year= 1985 | volume= 4 | issue= 5 | pages= 496-8 | pmid=3900945 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3900945  }} </ref><ref name="pmidPMID:    6421940">{{cite journal| author=Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP| title=Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever. | journal=J Infect Dis | year= 1984 | volume= 149 | issue= 2 | pages= 157-61 | pmid=PMID:    6421940 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6421940 }} </ref>
 
===Serology===
'''Widal test'''
'''Newer rapid antigen test'''
'''Elisa for chronic carriers'''


===other tests===
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
 
|+ '''Laboratory findings'''
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>
|-
! 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 ==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Overview

Nonspecific laboratory abnormalities associated with typhoid fever include decreased hemoglobin, decreased or increased leukocyte count, elevated CRP, and abnormal liver function tests.[1][2][3][4][5]

Laboratory findings

Microbial culture is the gold standard test for the diagnosis of typhoid fever.[2][3] Shown below is a table summarizing nonspecific laboratory abnormalities associated with typhoid fever.[5][6][7]

Laboratory findings
Test Findings
Complete blood count Decreased hemoglobin
Decreased hematocrit
Elevated CRP[5]
White blood cell count Elevated (children) or decreased leukocyte count (adults)
Biochemistry Hypoglycemia
Elevated creatinine
Elevated ALT, AST[8][7]
Possible hyponatremia
Acidosis: High lactate; Low bicarbonate (shock)
Coagulation Thrombocytopenia[5]
Urinalysis Proteinuria
hemoglobinuria (renal failure)

References

  1. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  2. ↑ 2.0 2.1 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.
  3. ↑ 3.0 3.1 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.
  4. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  5. ↑ 5.0 5.1 5.2 5.3 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.
  6. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  7. ↑ 7.0 7.1 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.
  8. ↑ 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.

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