Diagnosis of typhoid fever in adults
Last reviewed: 23.04.2024
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[Clinical diagnosis of typhoid fever
From epidemiological data, contact with febrile patients, the use of non-contaminated water, unwashed vegetables and fruits, unboiled milk and dairy products made from it and purchased from individuals, nutrition in public catering establishments with signs of sanitary trouble, a high incidence of intestinal infections at the place of stay patient. From the clinical data, the most important are high fever, rosaceous rash, adynamia, a characteristic kind of tongue, flatulence, enlarged liver and spleen, stool retardation, inhibition, sleep disturbance, headache, anorexia. All patients with a fever of unknown origin should be examined on an outpatient basis for typhoid fever.
Specific and nonspecific laboratory diagnostics of typhoid fever
The most informative diagnosis of typhoid fever is the isolation of the 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 sowing should be performed within 2-3 days daily, the first time - preferably before the appointment of antimicrobials. Blood is taken in the amount of 10-20 ml and is inoculated, respectively, to 100-200 ml of Rappoport medium or bile broth. From the second week of the disease until recovery, it is possible to isolate copro-, urino- and bioliocul- guris, but if the result of the test is positive, the possibility of chronic carriage should be excluded. Study bile is carried out on the tenth day after the normalization of body temperature. The sowing of these substrates, as well as the scarify of rosewood, sputum, cerebrospinal fluid, is carried out on selective media (bismuth sulfate agar, Ploskirev media, Endo agar and Levine agar). The preliminary result of bacteriological examination can be obtained after two days, the final, including the definition of sensitivity to antibiotics and phagotyping. - After 4-5 days.
To confirm the diagnosis, also use RA (Vidal's reaction), as well as a more sensitive and specific RIGA with H-, O- and Vi-antigen, which almost completely replaced Vidal's reaction. The study is conducted on admission and after 7-10 days. The diagnostic value is the increase in the titer of O-antibodies by a factor of four or by a titer of 1: 200 and higher. A positive reaction with H-antigen indicates a previous illness or vaccination, with Vi-antigen - a chronic typhoid fever. In recent years, ELISA has also been used to diagnose typhoid fever.
Differential diagnosis of typhoid fever
Differential diagnosis of typhoid fever is carried out with many diseases occurring with fever; more often with influenza, pneumonia, adenovirus infection, as well as with malaria, brucellosis, leptospirosis, ornithosis, rickettsiosis. Trichinosis, generalized form of yersiniosis, sepsis, miliary tuberculosis.