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Diagnosis of typhoid fever in adults
Last reviewed: 03.07.2025
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Clinical diagnosis of typhoid fever
The most important epidemiological data include contact with febrile patients, consumption of unsterilized water, unwashed vegetables and fruits, unboiled milk and dairy products prepared from it and purchased from private individuals, meals in public catering establishments with signs of poor sanitary conditions, and high incidence of intestinal infections at the patient's place of residence. The most important clinical data include high fever, roseola rash, adynamia, characteristic appearance of the tongue, flatulence, enlarged liver and spleen, constipation, lethargy, sleep disturbance, headache, and anorexia. All patients with fever of unknown genesis should be examined on an outpatient basis for typhoid fever.
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Specific and non-specific laboratory diagnostics of typhoid fever
The most informative diagnostics of typhoid fever is the isolation of a blood culture of the pathogen. A positive result can be obtained throughout the febrile period, but more often at the onset of the disease. Blood culture should be performed daily for 2-3 days, the first time - preferably before prescribing antimicrobial drugs. Blood is taken in the amount of 10-20 ml and seeded, respectively, on 100-200 ml of Rappoport's medium or bile broth. From the second week of the disease until recovery, it is possible to isolate copro-, urino- and bilioculgurus, however, with a positive test result, the possibility of chronic carriage must be excluded. Bile is examined on the tenth day after normalization of body temperature. Sowing of these substrates, as well as roseola scarificate, sputum, cerebrospinal fluid is performed on selective media (bismuth sulfate agar, Ploskirev media, Endo and Levin agars). The preliminary results of the bacteriological examination can be obtained in two days, the final results, including determination of sensitivity to antibiotics and phage typing - in 4-5 days.
To confirm the diagnosis, the Widal reaction is also used, as well as the more sensitive and specific RIGA with H, O and Vi antigen, which has almost completely replaced the Widal reaction. The study is conducted upon admission and after 7-10 days. A fourfold increase in the O-antibody titer or a titer of 1:200 or higher is of diagnostic value. A positive reaction with the H antigen indicates a previous illness or vaccination, with the Vi antigen - chronic typhoid fever carriage. In recent years, ELISA has also been used to diagnose typhoid fever.
Differential diagnosis of typhoid fever
Differential diagnostics of typhoid fever is carried out with many diseases that occur with fever; most often with influenza, pneumonia, adenovirus infection, as well as with malaria, brucellosis, leptospirosis, ornithosis, rickettsiosis, trichinosis, generalized form of yersiniosis, sepsis, miliary tuberculosis.