Typhoid fever: a review of its impact and diagnostic problems

A retrospective analysis was done on the diagnosis of typhoid fever based on clinical symptoms and available laboratory data over the last 16 years from rural areas of four African countries. This analysis concentrated on the reliability of diagnosis without cultures which cannot be performed in most rural hospitals due to lack of the necessary expertise and equipment. The analysis showed the problem to be increasing perhaps because of interaction of salmonella infection with human immunodeficiency virus (HIV), malnutrition and other infections together with neglected sanitary facilities and lack of clean water. The use of certain cardinal clinical symptoms combined with available laboratory tests were shown to enhance the diagnosis of typhoid fever, especially in vulnerable persons. In conclusion the paper suggests that using the approach followed to obtain this data in rural tropical areas one can confidently make a diagnosis of typhoid fever.