Acute and Chronic Disease Reports
Open Access

Diagnosing Typhoid Fever: Advances in Testing and Treatment

Daiki Ito^{* *}Correspondence: Daiki Ito, Department of Medicine, The University of Tokyo, Tokyo, Japan, Email:

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Description

Typhoid fever, caused by Salmonella enterica, remains a significant health concern worldwide, particularly in low- and middle-income countries. It is characterized by symptoms such as prolonged fever, abdominal pain, malaise and sometimes gastrointestinal bleeding. Accurate diagnosis and timely treatment are important for preventing complications and reducing mortality rates. In recent years, advancements in diagnostic techniques and treatment options have improved our ability to manage typhoid fever more effectively. This communication explores the latest developments in the diagnosis and treatment of typhoid fever. Early and accurate diagnosis of typhoid fever is important for effective treatment, as delays can lead to severe complications such as intestinal perforation and septicemia. Traditional methods for diagnosing typhoid fever, including the widal test and blood cultures, have been widely used, but they have limitations that have spurred the development of more advanced diagnostic tools. Blood cultures remain the gold standard for diagnosing typhoid fever, as they allow for the isolation of Salmonella typhi from the bloodstream. However, the sensitivity of blood cultures can be as low as 40%-60% in endemic areas, due to factors such as antibiotic use prior to testing and improper collection techniques. Furthermore, blood cultures require specialized laboratory facilities and can take several days to yield results, which can delay the initiation of appropriate treatment. The widal test, which detects antibodies against Salmonella antigens, has long been used as a diagnostic tool for typhoid fever. While it is simple and inexpensive, its accuracy is compromised due to crossreactivity with other infections, as well as variations in antibody levels across populations. In endemic areas, individuals may carry antibodies without having an active infection, leading to false positives. Therefore, the widal test is no longer relied upon as a definitive diagnostic tool in many settings, though it can still be helpful when used in conjunction with clinical assessment. Polymerase Chain Reaction (PCR) and Real-Time Polymerase Chain Reaction (RT-PCR) have emerged as highly sensitive methods for detecting Salmonella typhi DNA in clinical samples, including blood, stool and urine. These molecular techniques offer greater specificity and sensitivity compared to traditional methods. PCR-based methods can detect infections earlier in the disease process, even before antibodies are detectable. Additionally, PCR can differentiate Salmonella typhi from other pathogens, reducing the likelihood of misdiagnosis. RT-PCR also allows for the quantification of bacterial load, providing valuable information about disease severity. Rapid Diagnostic Tests (RDTs) have been developed as a faster, more affordable alternative to blood cultures and PCR. These tests typically involve lateral flow assays that detect antigens or antibodies specific to Salmonella typhi. Several commercially available RDTs, such as the typhoid IgG/IgM test, can provide results within 15-30 minutes. While RDTs offer the advantage of rapid results and ease of use in resource-limited settings, their sensitivity and specificity can vary and false positives/negatives remain a concern. Nonetheless, RDTs are a promising tool for improving diagnosis in remote areas where access to advanced laboratory facilities is limited. The treatment of typhoid fever has traditionally involved antibiotics, but the emergence of antibiotic-resistant strains of Salmonella typhi has complicated management. Overuse and misuse of antibiotics, particularly in areas with inadequate healthcare systems, have contributed to the growing problem of drug resistance. In response, advancements in antibiotic treatment and resistance management have become central to controlling the disease.

Conclusion

Advances in diagnostic techniques, such as PCR-based methods and rapid diagnostic tests, have improved the ability to detect typhoid fever early and accurately, particularly in resource-limited settings. However, antibiotic resistance remains a major challenge and alternative treatments such as azithromycin and third-generation cephalosporin have become important for managing the disease. Prevention through vaccination and improved hygiene is also critical in reducing the global burden of typhoid fever. With continued studies and innovation, the management of typhoid fever will continue to improve, helping to reduce its impact on public health worldwide. Vaccination, combined with improvements in sanitation, access to clean water and public health initiatives, can significantly reduce the incidence of typhoid fever.