Summary
Definition
History and exam
Key diagnostic factors
- high fever
Other diagnostic factors
- dull frontal headache
- abdominal pain
- anorexia
- apathetic-lethargic state
- constipation
- cough
- diarrhea
- malaise
- nausea
- prostration
- chills
- hepatomegaly
- pneumonia
- relative bradycardia
- rigors
- rose spots
- splenomegaly
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 traveling in endemic countries
- travel to the Indian subcontinent
- longer duration of stay in endemic country
Diagnostic investigations
1st investigations to order
- CBC
- serum aminotransferases
- blood culture
- stool culture
- urine culture
- bone marrow culture
Investigations to consider
- rose spot culture
- Widal test
Emerging tests
- IDL Tubex® test
- Typhidot-M®
- sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE)/immunoblot
Treatment algorithm
suspected typhoid
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
relapse
Contributors
Authors
Eli Schwartz, MD, DTMH

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

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.
Differentials
- Malaria
- Dengue
- Typhus
More DifferentialsGuidelines
- Canadian immunization guide part 4 - active vaccines: typhoid vaccine
- Updated recommendations for the use of typhoid vaccine
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