eMedicine Specialties > Ophthalmology > Infectious Disease

Typhoid Fever: Differential Diagnoses & Workup

Author: Theodore Curtis, MD, Assistant Professor of Ophthalmology, University of Colorado; Consulting Staff, Rocky Mountain Lions Eye Institute
Coauthor(s): David T Wheeler, MD, Associate Professor, Departments of Ophthalmology and Pediatrics, Oregon Health & Science University
Contributor Information and Disclosures

Updated: Sep 29, 2006

Differential Diagnoses

Abducens Nerve Palsy
Oculomotor Nerve Palsy
Optic Neuritis, Adult
Retinal Detachment, Exudative
Trochlear Nerve Palsy
Ulcer, Corneal

Workup

Laboratory Studies

  • New diagnostic tests include those for immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies, with rapid results (2 minutes to 3 hours). The Typhidot-M test has a specificity of 75% and a sensitivity of 95%. The Tubex test is rapid and detects the O9 antigen.
  • The classic Widal test is rarely used because of its low sensitivity and specificity.
  • Blood, urine, and stool cultures are still frequently used to isolate S typhi, but the yield is only about 70%. The duodenal string test may be used to culture bile.
  • CBC may reveal anemia and thrombocytopenia.
  • Liver function test results are commonly elevated.
  • Renal dysfunction may occur, but chronic renal failure has not been reported.

Imaging Studies

  • Abdominal radiographs demonstrate free air in cases of intestinal perforation.

Procedures

  • Bone marrow biopsy results are positive in as many as 90% of individuals who are affected; therefore, performing a bone marrow biopsy is useful in cases of diagnostic uncertainty.

Histologic Findings

S typhi is a motile, gram-negative bacillus.

More on Typhoid Fever

Overview: Typhoid Fever
Differential Diagnoses & Workup: Typhoid Fever
Treatment & Medication: Typhoid Fever
Follow-up: Typhoid Fever
References
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References

  1. Ackers ML, Puhr ND, Tauxe RV, et al. Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA. May 24-31 2000;283(20):2668-73. [Medline].

  2. Akalin HE. Quinolones in the treatment of typhoid fever. Drugs. 1999;58 Suppl 2:52-4. [Medline].

  3. Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet. Aug 27-Sep 2 2005;366(9487):749-62. [Medline].

  4. Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. Jul 8 2006;333(7558):78-82. [Medline].

  5. Davis TM, Makepeace AE, Dallimore EA, et al. Relative bradycardia is not a feature of enteric fever in children. Clin Infect Dis. Mar 1999;28(3):582-6. [Medline].

  6. Engels EA, Lau J. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2000;(2):CD001261. [Medline].

  7. Hanel RA, Araujo JC, Antoniuk A, et al. Multiple brain abscesses caused by Salmonella typhi: case report. Surg Neurol. Jan 2000;53(1):86-90. [Medline].

  8. Ismail TF. Rapid diagnosis of typhoid fever. Indian J Med Res. Apr 2006;123(4):489-92. [Medline].

  9. Jong EC. Travel immunizations. Med Clin North Am. Jul 1999;83(4):903-22, vi. [Medline].

  10. Julia J, Canet JJ, Lacasa XM, et al. Spontaneous spleen rupture during typhoid fever. Int J Infect Dis. 2000;4(2):108-9. [Medline].

  11. Khan M, Coovadia YM, Connolly C, et al. Influence of sex on clinical features, laboratory findings, and complications of typhoid fever. Am J Trop Med Hyg. Jul 1999;61(1):41-6. [Medline].

  12. Noyola DE, Fernandez M, Kaplan SL. Reevaluation of antipyretics in children with enteric fever. Pediatr Infect Dis J. Aug 1998;17(8):691-5. [Medline].

  13. Parry CM, Hien TT, Dougan G. Typhoid fever. N Engl J Med. Nov 28 2002;347(22):1770-82. [Medline].

  14. Thomsen LL, Paerregaard A. Treatment with ciprofloxacin in children with typhoid fever. Scand J Infect Dis. 1998;30(4):355-7. [Medline].

  15. World Health Organization. Background document: the diagnosis, treatment, and prevention of typhoid fever. Geneva, Switzerland: 2003.

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Further Reading

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Keywords

enteric fever, Salmonella typhi

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Contributor Information and Disclosures

Author

Theodore Curtis, MD, Assistant Professor of Ophthalmology, University of Colorado; Consulting Staff, Rocky Mountain Lions Eye Institute
Theodore Curtis, MD is a member of the following medical societies: American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus
Disclosure: Nothing to disclose.

Coauthor(s)

David T Wheeler, MD, Associate Professor, Departments of Ophthalmology and Pediatrics, Oregon Health & Science University
David T Wheeler, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Diseases Service, Assistant Department of Ophthalmology, Assistant Dean for Graduate Medical Education and Continuing Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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