What nonspecific lab results are common in typhoid fever (enteric fever)?

Updated: Aug 19, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Since the sensitivity of cultures of blood, bone marrow, urine and stool vary with the duration of disease, various nonspecific tests have been studied regarding usefulness in diagnosing typhoid fever.

Most patients with typhoid fever are moderately anemic, have an elevated erythrocyte sedimentation rate (ESR), thrombocytopenia, and relative lymphopenia.

Most also have a slightly elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT) and decreased fibrinogen levels.

Circulating fibrin degradation products commonly rise to levels seen in subclinical disseminated intravascular coagulation (DIC).

Liver transaminase and serum bilirubin values usually rise to twice the reference range.

Mild hyponatremia and hypokalemia are common.

A combination of absolute eosinopenia, elevated aspartate aminotransferase levels, and elevated C-reactive protein levels (>40 mg/L) have been shown to be a positive predictor of S typhi and S paratyphi bacteremia. [44]

A serum alanine amino transferase (ALT)–to–lactate dehydrogenase (LDH) ratio of more than 9:1 appears to be helpful in distinguishing typhoid from viral hepatitis. A ratio of greater than 9:1 supports a diagnosis of acute viral hepatitis, while ratio of less than 9:1 supports typhoid hepatitis. [45]

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