DIAGNOSIS OF TYPHOID FEVER

DIAGNOSTICS EXPECTED FINDINGS

Complete Blood Count Neutropenia/leukopenia/leukocytosis/thrombocytopenia
Normochromic anemia; hypochromia with blood loss
Blood Culture Gold standard: should be taken from at least two different sites
Can be taken anytime during the illness but yield is highest during the first 2 weeks
Stool Culture May be positive during the 3rd week of illness in untreated patients
Bone Marrow Culture Not usually done, but indicated in highly suspicious cases or if negative blood/stool
culture
Can be done anytime during the illness
Yield is high (~90%): yield not reduced by up to 5 days of prior antibiotic therapy
Widal Test (Serology) Not specific, false positives may occur
MANAGEMENT OF TYPHOID FEVER
INDICATION AGENTS DOSAGE & ROUTE DURATION (DAYS)
Empirical Treatment Ceftriaxone 2 g/d IV 10 14
Azithromycin 1 g/d PO 5
Fully Susceptible Ciprofloxacin (first line) 500 mg BID PO or 57
400 mg q12h IV
Azithromycin 1 g/d PO 5
Amoxicillin 1 g TID PO or 2 g q6h IV 14
Chloramphenicol 25 mg/kg TID PO or IV 14 21
TMP-SMX 160/800 mg BID PO 7 14
Multidrug-resistant Ceftriaxone 2 g/d IV 10 14
Azithromycin 1 g/d PO 5

Quinolone-resistant Ceftriaxone 2 g/d IV 10 14

Azithromycin 1 g/d PO 5
PREVENTION
Food and water
Safe food and water precautions and frequent handwashing
Vaccination
For travelers to areas with increased risk of exposure to S. enterica serotype
Typhi
Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi) for intramuscular use
Oral live attenuated vaccine (Vivotif, from the Ty21a strain of serotype Typhi)
Available typhoid vaccins offer no protection against paratyphoid fever
 VACCINATION AGE DOSE, NUMBER OF DOSING BOOSTING
MODE OF ADMINISTRATION DOSES INTERVAL INTERVAL

ORAL, LIVE ATTENUATED Ty21a VACCINE (VIVOTIF)1

Primary Series 6 1 Capsule, PO 4 48 hours Not applicable
Booster 6 1 Capsule, PO 4 48 hours Every 5 years

Vi CAPSULAR POLYSACCHARIDE VACCINE (TYPHIM Vi)

Primary Series 2 0.50 mL, IM 1 Not applicable Not applicable
Booster 2 0.50 mL, IM 1 Not applicable Every 2 years