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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

Other diagnostic studies associated with typhoid fever include microbial culture, serology and PCR. However, microbial culture is the gold standard tests for diagnosing typhoid fever:[1][2][3][4][3][5][6][4][7][3][6][8][9][10][11]

Other Diagnostic studies

Other diagnostic studies associated with typhoid fever include microbial culture, serology and PCR. However, microbial culture is the gold standard tests for diagnosing typhoid fever:[1][2]

Microscopic diagnosis

Culture

Cultures from the following sites may help establishing the diagnosis.[1][7][3][5][12]

Blood culture

  • Standard means of establishing the diagnosis.[3]
  • May be positive prior to the antibiotic use.[4]
  • 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.[3]

Bone marrow culture

  • Most sensitive.[5][6]
  • Positive in 80 to 95 percent cases.[4]

Culture from the other sites

  • Urine culture
  • Culture of the skin lesions (rose spots)[7]
  • Culture of the duodenal contents[3][6]

Molecular diagnosis

Serology

  • Widal Test
  • Detection of antibodies against O and H antigen of Salmonella enterica serotype.[8]
  • 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.[13]
  • Newer Antibody Tests
  • Typhidot test[14]
  • May be used in areas lacking facilities for culture detection of S.typhi.[10]

PCR

  • May help detect S.typhi in culture negative patients with strong clinical suspicion.[11]

References

  1. 1.0 1.1 1.2 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. 2.0 2.1 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: 1683–7. PMC 104900. PMID 9620400. Unknown parameter |obiological issue= ignored (help)
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 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.
  4. 4.0 4.1 4.2 4.3 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.
  5. 5.0 5.1 5.2 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. 6.0 6.1 6.2 6.3 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).
  7. 7.0 7.1 7.2 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.
  8. 8.0 8.1 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.
  9. 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.
  10. 10.0 10.1 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.
  11. 11.0 11.1 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.
  12. 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.
  13. 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.
  14. 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.

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