Diagnosis and Management of Typhoid Fever

Diagnostic Recommendations

The Infectious Diseases Society of America explicitly states that serologic tests should NOT be used to diagnose enteric fever due to poor performance characteristics 1
The CDC requires isolation of Salmonella typhi from clinical specimens for confirmation and states that serologic evidence alone is not sufficient 2
Blood culture is the gold standard diagnostic test and should be performed in all patients with clinical suspicion of enteric fever 2, 3
The American College of Physicians and the Infectious Diseases Society of America recommend blood culture as the first-line diagnostic test for typhoid fever 1, 5

Adjunctive tests such as stool, duodenal fluid, and urine cultures may be beneficial in diagnosing typhoid fever 1, 2
Bone marrow culture has higher sensitivity than blood culture in patients who have already received antibiotics or have negative blood cultures despite high clinical suspicion 2, 3

Fever is present in 97-100% of typhoid fever cases, and travel history to endemic areas should raise suspicion 4, 5, 6
Sustained high-grade fever with headache, malaise, and abdominal pain are common symptoms of typhoid fever 5, 6
The incubation period of typhoid fever is 7-18 days after exposure 6
Diarrhea is uncommon in enteric fever 5