Typhoid infection

Last reviewed: 27 Apr 2022
Last updated: 19 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • high fever
More key diagnostic factors

Other diagnostic factors

  • dull frontal headache
  • abdominal pain
  • anorexia
  • apathetic-lethargic state
  • constipation
  • cough
  • diarrhoea
  • malaise
  • nausea
  • prostration
  • chills
  • hepatomegaly
  • pneumonia
  • relative bradycardia
  • rigors
  • rose spots
  • splenomegaly
Other diagnostic factors

Risk factors

  • overcrowded living in endemic areas
  • poor sanitation/untreated water in endemic areas
  • poor personal hygiene in endemic areas
  • visiting endemic countries (e.g., Indian subcontinent, Mexico)
  • travel to areas with poor sanitation within endemic countries
  • ignoring hygiene rules while travelling in endemic countries
  • travel to the Indian subcontinent
  • longer duration of stay in endemic country
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • serum transaminases
  • blood culture
  • stool culture
  • urine culture
  • bone marrow culture
More 1st investigations to order

Investigations to consider

  • rose spot culture
  • Widal's test
More investigations to consider

Emerging tests

  • IDL Tubex® test
  • Typhidot-M®
  • sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE)/immunoblot

Treatment algorithm

INITIAL

suspected typhoid

ACUTE

isolate sensitive to all antibiotics

isolate multidrug-resistant but sensitive to fluoroquinolones

isolate multidrug-resistant but sensitive to cephalosporins

isolate resistant to both cephalosporins and fluoroquinolones

isolate extensively drug-resistant

ONGOING

relapse

Contributors

Authors

Eli Schwartz, MD, DTMH
Eli Schwartz

Professor

Center for Geographical Medicine and Tropical Diseases

Chaim Sheba Medical Center

Tel HaShomer Hospital

Clinical Professor of Medicine

Sackler Faculty of Medicine

Tel Aviv University

Tel Aviv

Israel

Disclosures

ES is an author of a number of references cited in this topic.

Bradley A. Connor, MD
Bradley A. Connor

Clinical Associate Professor

Weill Medical College of Cornell University

New York Center for Travel and Tropical Medicine

New York City

NY

Disclosures

BAC declares that he has no competing interests.

Peer reviewers

Chris Parry, MD

Senior Lecturer (Honorary Consultant)

Division of Medical Microbiology and Genitourinary Medicine

School of Infection and Host Defence

University of Liverpool

Liverpool

UK

Disclosures

CP declares that he has no competing interests.

Paul M. Southern, MD, MSc, DTM&H

Professor

Department of Pathology

University of Texas Southwestern Medical Center

Dallas

TX

Disclosures

PMS declares that he has no competing interests.

  • Typhoid infection images
  • Differentials

    • Malaria
    • Dengue
    • Typhus
    More Differentials
  • Guidelines

    • Public health operational guidelines for typhoid and paratyphoid (enteric fever)
    • Canadian immunization guide part 4 - active vaccines: typhoid vaccine
    More Guidelines
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