Which laboratory tests are most effective for confirming a diagnosis of typhoid fever?

The most effective laboratory tests for confirming a diagnosis of typhoid fever include blood culture as the gold standard, supported by serological tests such as the Widal test and newer rapid diagnostic tests like TUBEX® TF. Blood culture remains the definitive diagnostic method due to its ability to directly isolate Salmonella Typhi, especially in the first week of illness, although its sensitivity can be affected by prior antibiotic use and requires laboratory infrastructure NICE NG143. Serological tests like the Widal test are widely used but have limitations in sensitivity and specificity, particularly in endemic areas where baseline antibody levels may be elevated NICE NG143. Recent advances highlight the utility of rapid immunoassays such as TUBEX® TF, which detect anti-Salmonella antibodies and have shown improved accuracy and faster turnaround times compared to traditional serology, making them valuable adjuncts in resource-limited settings Bundalian R Jr et al. 2019. Molecular methods like PCR offer high sensitivity and specificity but are less commonly used in routine practice due to cost and technical demands Neupane et al. 2021. Therefore, a combination of blood culture for confirmation and rapid serological tests for initial screening is currently the most effective approach to confirm typhoid fever in clinical practice NICE NG143; Ajibola et al. 2018Bundalian R Jr et al. 2019Neupane et al. 2021.