Typhoid

Key Information

Appropriate Tests

 

Blood culture, Faeces MCS and antigen. MCS urine.

A similar syndrome may be caused by Salmonella paratyphi, which can be distinguished from S. typhi on culture.

Culture of pus of specimen from local sites of infection (eg, bone marrow, lymph node) if diagnosis has not been established on culture of blood, faeces and urine. Full blood count, Blood film.

Typhoid Ab (Widal test) is of only very limited value, as both false negative and positive results are common.

Presentation

 

Fever

Headache

Rose spots

Hepatomegaly

Splenomegaly

Lymphadenopathy (cervical)

Anaemia

Neutropenia

See Pyrexia of unknown origin

Complications

 

Intestinal haemorrhage

Intestinal perforation

Osteomyelitis

Endocarditis

Myocarditis - toxic

 

Relapse

Relapse occurs in approximately 10% of treated patients: documentation is by repeat cultures before immediate treatment.

Asymptomatic carrier state

Faeces MCS and antigen (repeated culture may be required).