Sampai saat ini, baku emas diagnosis demam tifoid adalah pemeriksaan biakan empedu walaupun hanya

40%-60% kasus biakan positif, terutama pada awal perjalanan penyakit. Biakan spesimen tinja dan urin
menjadi positif setelah akhir minggu pertama infeksi, namun sensitivitasnya lebih rendah. Di negara
berkembang, ketersediaan dan penggunaan antibiotik secara luas, menyebabkan sensitivitas biakan
darah menjadi rendah. Biakan sumsum tulang lebih sensitif, namun sulit dilakukan dalam praktek,
invasif, dan kurang digunakan untuk kesehatan masyarakat. https://fk.ui.ac.id/wp-
content/uploads/2016/01/Buku-PKB-63.pdf Interpretasi pemeriksaan Widal harus dilakukan secara hati-
hati karena beberapa faktor mempengaruhi hasilnya, antara lain stadium penyakit, pemberian
antibiotik, teknik laboratorium, endemisitas penyakit tifoid, gambaran imunologi masyarakat setempat,
dan riwayat imunisasi demam tifoid. Sensitivitas dan spesifisitas rendah tergantung kualitas antigen
yang digunakan bahkan dapat memberikan hasil negatif pada 30% sampel biakan positif demam tifoid. 5
Pemeriksaan Widal memiliki sensitivitas 40%, spesifisitas 91,4%, dan nilai prediksi positif 80%. Hasil
pemeriksaan Widal positif palsu dapat terjadi oleh karena reaksi silang dengan non-typhoidal
Salmonella, enterobacteriaceae, pemeriksaan dilakukan di daerah endemis infeksi dengue dan malaria,
riwayat imunisasi tifoid, dan preparat antigen komersial yang bervariasi serta standardisasi yang kurang
baik. Pemeriksaan Widal pada serum akut satu kali saja tidak mempunyai arti penting dan sebaiknya
dihindari oleh karena beberapa alasan, yaitu variablitas alat pemeriksaan, kesulitan memperoleh titer
dasar dengan kondisi stabil, paparan berulang S.typhi di daerah endemis, reaksi silang terhadap
nonSalmonella lain, dan kurangnya kemampuan reprodusibilitas hasil pemeriksaan tersebut.
Pemeriksaan serologi untuk aglutinin Salmonella seperti pemeriksaan Widal bahkan tidak dianjurkan.8

Diagnosis of typhoid Typhoid is diagnosed by culture of the organism Salmonella Typhi from any clinical
specimen. 1. Blood culture is the specimen of choice. Submit blood cultures as soon as possible. Blood
cultures may be positive in up to 50-80% of cases 2. Stool culture may be useful, especially in children.
Organisms are shed in the stool only after the first week of illness 3. Bone marrow aspirate is positive in
90% of cases but is an invasive specimen. 4. Urine cultures may be useful. Blood culture is the diagnostic
test of choice given the limitations of testing other specimen types. Furthermore, blood culture provides
the means for conducting antimicrobial resistance testing, which is important in treatment choice (see
Section 3.1). The sensitivity of blood culture is 50-80%. It is limited by the small numbers of Salmonella
Typhi bacilli present in blood and the use of antibiotics before specimen collection, and varies by volume
of blood collected and the system used for culturing. The isolation of Salmonella Typhi from stool is
suggestive of acute typhoid fever when associated with a clinically compatible illness; however, stool
culture does not replace blood culture as a diagnostic specimen due to a number of limitations. Firstly,
bacilli are shed in stool only after the first week of illness. Secondly, only 30% of adult cases, and 60% of
paediatric cases, will have a positive stool culture. Thirdly, typhoid carriers may also have a positive stool
culture. Bone marrow culture is considered the most sensitive (90%) of the clinical specimens for
isolation of Salmonella Typhi; however, sample collection is painful and invasive, and requires technical
expertise and appropriate surgical equipment. Furthermore, the sensitivity of blood culture is
approaching that of bone marrow culture due to recent advances in technology. Therefore, bone
marrow culture is not routinely recommended to diagnosis of typhoid fever. A bone marrow aspirate
may be indicated in patients who have been previously treated, who have a long history of illness and
for whom there has been a negative blood culture with the recommended volume of blood.
Furthermore, bone marrow aspirates collected for other indications (e.g. cytopenias) may be subjected
to culture for Salmonella Typhi.
SUSPECTED CASE OF TYPHOID OR PARATYPHOID FEVER FOR CASE FINDING h Fever for at least three out
of seven consecutive days in an endemic area or following travel from an endemic area OR h Fever for at
least three out of seven consecutive days within 28 days of being in household contact with a confirmed
case of typhoid or paratyphoid fever

CONFIRMED CASES h Typhoid fever: Laboratory confirmation by culture or molecular methods of S.

Typhi or detection of S. Typhi DNA from a normally sterile site.