Comparative results between bone marrow culture and blood culture in the diagnosis of Typhoid fever

Abstract

The early, wide use of antimicrobial agents in febrile disease has changed the clinical manifestations of typhoid fever (TF) in Indonesia. The classical textbook picture is now rarely observed. The aim of the study is to compare bone marrow culture and blood culture in the diagnosis of TF. Samples were obtained from patients (>13 years old) admitted to tropical ward Dr. Sutomo General Hospital Surabaya with clinical picture of TF, and blood and bone marrow culture were performed. Clinical diagnosis of TF was made on the basis of: A history of fever (> 5 days) plus the documentation of high fever (>38°C) in the hospital (essential diagnosis) and the combination of at least six of the of the following : residence in a known typhoid endemic area; a family history of typhoid; the failure of fever to resolve after the exclusion of other cause of prolonged fever; hepatomegaly, doughy abdomen; abdominal ileus; an elevated level of C-reactive protein; leucocytosis or leucopenia and documentation of specific complication of typhoid e.g. intestinal perforation. This study was conducted from mid May 1997 to mid October 1997. Result: Until mid July 1997, we collected twenty-one samples. From those samples, sixteen samples of bone marrow culture were positive, consisted of thirteen positive S. typhi and three positive S. paratyphi A. In comparison with blood culture, there's only one sample of blood culture negative, in which bone marrow culture was positive for S. typhi, but on the contrary there’s one blood culture positive for S. typhi while bone marow culture was still negative. Among fourteen blood/bone marrow culture positive S. typhi, three samples came from complication of typhoid (2 CNS manifestations, 1 small bowel perforation). Based on statistical analysis, there is no significant difference between bone marrow culture and blood culture results in the diagnosis of TF. Conclusion: bone marrow culture showed positive growth faster than blood culture but made no significant difference in the diagnosis of TF.