Health Dictionary
Reliable, easy-to-read patient information on common medical conditions β written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Typhoid fever differential diagnosis
Introduction
Overview
Overview
Typhoid fever must be differentiated from other diseases that cause fever, diarrhea, and dehydration, such as Ebola, Shigellosis, malaria, and Lassa fever.
Differentiating Typhoid fever from other Diseases
Differentiating Typhoid fever from other Diseases
The table below summarizes the findings that differentiate Typhoid fever from other conditions that cause fever, diarrhea, dehydration, and non-specific abdominal symptoms.[1][2][3][4][5][6][7][8]
| Disease | Findings |
|---|---|
| Typhoid fever-like syndrome | Caused by Salmonella Paratyphi A, B, C or Choleraesuis. Presents with fever, chills, vomiting, abdominal pain, generalized pain or malaise following an incubation period of 5-21 days. |
| Ebola | Presents with fever, chills, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding following an incubation period of 2-21 days. |
| Shigellosis & other bacterial enteric infections | Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leukocytosis distinguishes bacterial infections from viral infections. |
| Malaria | Presents with acute fever, headache, and sometimes diarrhea (in children). A blood smear must be examined for malaria parasites. The presence of parasites does not exclude concurrent viral infection. An antimalarial should be prescribed as an empiric therapy. |
| Lassa fever | Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common. |
| Yellow fever and other Flaviviridae | Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation are helpful for distinguishing these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever. |
| Abdominal abscess (e.g., ameobic hepatic abcess) | May present with abdominal pain, fever, loss of appetite, nausea, vomiting, diarrhea, constipation. H/o surgery, presence of a mass on physical examination, ultrasound or CT scan may help rule out abdominal abscess in such cases. |
| Brucellosis | Presents with recurrent fevers, acute abdominal pain, and other symptoms resembling typhoid fever. History of exposure to infected animals, including work in a slaughterhouse or as a veterinarian, may help differentiate brucellosis from typhoid fever. |
| Others | Viral hepatitis, leptospirosis, rheumatic fever, typhus, appendicitis, dengue fever,toxoplasmosis, rickettsial diseases, leishmaniasis, tuberculosis, and mononucleosis can produce signs and symptoms that may be confused with typhoid fever in the early stages of infection. |
| Differentiating diagnosis of Typhoid fever | Symptoms | Signs | Diagnosis | Additional Findings | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Fever | Rash | Diarrhea | Abdominal pain | Weight loss | Painful lymphadenopathy | Hepatosplenomegaly | Arthritis | Lab Findings | ||
| Brucellosis | β | β | β | β | β | β | β | β | Relative lymphocytosis | Night sweats, often with characteristic smell, likened to wet hay |
| Typhoid fever | β | β | β | β | β | β | β | β | DecreasedΒ hemoglobin | Incremental increase in temperature initially and than sustainedΒ feverΒ as high as 40Β°C (104Β°F) |
| Malaria | β | β | β | β | β | β | β | β | Microcytosis,
elevatedΒ LDH |
“Tertian” fever: paroxysms occur every second day |
| Tuberculosis | β | β | β | β | β | β | β | β | Mild normocyticΒ anemia, hyponatremia, and | Night sweats, constant fatigue |
| Lymphoma | β | β | β | β | β | β | β | β | Increase ESR, increased LDH | Night sweats, constant fatigue |
| Mumps | β | β | β | β | β | β | β | β | Relative lymphocytosis, serum amylase elevated | Parotid swelling/tenderness |
| Rheumatoid arthritis | β | β | β | β | β | β | β | β | ESR and CRP elevated, positive rheumatoid factor | Morning stiffness |
| SLE | β | β | β | β | β | β | β | β | ESR and CRP elevated, positive ANA | Fatigue |
| HIV | β | β | β | β | β | β | β | β | Constant fatigue | |
References
References
- β “CDC Typhoid Fever”. Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
- β “Reorganized text”. JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMIDΒ 25996397.
- β Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). “Typhoid fever”. N Engl J Med. 347 (22): 1770β82. doi:10.1056/NEJMra020201. PMIDΒ 12456854.
- β MacFadden DR, Bogoch II, Andrews JR (2016). “Advances in diagnosis, treatment, and prevention of invasive Salmonella infections”. Curr Opin Infect Dis. 29 (5): 453β458. doi:10.1097/QCO.0000000000000302. PMIDΒ 27479027.
- β Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J; et al. (2009). “Typhoid fever in the United States, 1999-2006”. JAMA. 302 (8): 859β65. doi:10.1001/jama.2009.1229. PMIDΒ 19706859.
- β GΓΌleΕen R, Levent B, Γvey M, Bayrak H, Akgeyik M (2016). “[Serotype distribution and antimicrobial susceptibilities of Salmonella strains recovered from environmental samples between 2008-2014]”. Mikrobiyol Bul. 50 (3): 371β81. PMIDΒ 27525393.
- β SAPHRA I, WASSERMANN M (1954). “Salmonella cholerae suis: a clinical and epidemiological evaluation of 329 infections identified between 1940 and 1954 in the New York Salmonella Center”. Am J Med Sci. 228 (5): 525β33. PMIDΒ 13207112.
- β GΓΆke M, Neurath M, Braunstein S, Daniello S, Knolle P, Dippold W; et al. (1993). “Brucellosis: differential diagnosis of acute abdominal pain”. Z Gastroenterol. 31 (11): 671β4. PMIDΒ 8291280.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: JoΓ£o AndrΓ© Alves Silva, M.D. [2], Aysha Aslam, M.B.B.S[3]