Clinical features and early diagnosis of typhoid fever emphasizing usefulness of detecting mesenteric lymphadenopathy with ultrasound as diagnostic method

Typhoid fever is endemic in Pakistan. Most patients are children. As the symptoms and signs are often unspecific, it is difficult to diagnose typhoid fever without blood culture. We retrospectively reviewed 51 cases of typhoid fever who were all admitted from 1 June through 31 August 2002. Sixteen cases were positive by blood culture and confirmed as typhoid fever. All cases had Salmonella typhi. Although 16 cases were culture-negative, they were clinically diagnosed as typhoid fever. The remaining 19 cases were clinically diagnosed without blood culture. The clinical features of the culture-confirmed cases were more severe than the culture-negative cases. Mesenteric lymphadenopathy was very frequently detected with ultrasonography, in both culture-confirmed and culture-negative cases. The rates of detecting mesenteric lymphadenopathy were 69% and 63%, respectively. Meanwhile, the rate in non-typhoid fever patients was 5.5%. It was considered that detecting mesenteric lymphadenopathy with ultrasonography was very useful in the diagosis of typhoid fever in endemic areas.