Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children

The relative efficacy of cultures made from duodenal contents (obtained by string capsules), bone marrow, blood and rectal swab was compared in 118 pediatric patients, 2 to 13 years old with suspected typhoid fever. Only 47% of children 2 to 6 years old tolerated the string device, as compared with 89% in children 7 to 13 years old (P < 0.05). The four culture techniques were performed and at least one was positive for Salmonella typhi in 43 patients. Bone marrow cultures were positive in 84% of the confirmed cases, a sensitivity significantly greater than for duodenal contents (42%), blood (44%) and stool (65%) cultures. Higher recovery rates for blood cultures were found during the first week of illness than later (70 vs. 22%). Bone marrow cultures remain the most effective method for the recovery of S. typhi. Stool cultures appear to be more effective in children than in adults. Duodenal contents cultures offer little advantage in young (2 to 6 years old) children.