Typhoid fever physical examination: Difference between revisions
Aysha Aslam (talk | contribs) |
Aysha Aslam (talk | contribs) No edit summary |
||
(22 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Typhoid fever}} | {{Typhoid fever}} | ||
{{CMG}}; {{AE}} {{AAA}} | |||
{{CMG}}; {{AE}}{{ | |||
== Overview == | == Overview == | ||
Common physical examination findings of typhoid fever include stepwise increase in temperature, [[bradycardia]],<ref name="pmid8945708">{{cite journal| author=Ostergaard L, Huniche B, Andersen PL| title=Relative bradycardia in infectious diseases. | journal=J Infect | year= 1996 | volume= 33 | issue= 3 | pages= 185-91 | pmid=8945708 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8945708 }} </ref> [[abdominal tenderness]], and [[hepatosplenomegaly]] initially. In the third week of illness the patient may present with signs of complications.<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref><ref name="pmid26649174">{{cite journal| author=Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA| title=Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. | journal=J Glob Health | year= 2015 | volume= 5 | issue= 2 | pages= 020407 | pmid=26649174 | doi=10.7189/jogh.05.020407 | pmc=4672836 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26649174 }} </ref> Physical examination findings are dependent upon the timing of presentation. | |||
== Physical examination == | == Physical examination == | ||
Common physical examination findings of [[typhoid fever]] are described in the following table:<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref><ref name="pmid26649174">{{cite journal| author=Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA| title=Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. | journal=J Glob Health | year= 2015 | volume= 5 | issue= 2 | pages= 020407 | pmid=26649174 | doi=10.7189/jogh.05.020407 | pmc=4672836 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26649174 }} </ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
Line 19: | Line 17: | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | General Appearance | ! rowspan="1" | General Appearance | ||
| colspan="1" style="width: 300px;" | * | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | * | *Mild distress | ||
| colspan="1" style="width: 300px;" | * | | colspan="1" style="width: 300px;" | | ||
*Delirious or unconscious<ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | *Acute distress | ||
| colspan="1" style="width: 300px;" | | |||
*Severe distress | |||
*Delirious or [[unconscious]]<ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | |||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Vital signs | ! rowspan="1" | Vital signs | ||
| colspan="1" style="width: 300px;" | *Step-wise increase in temperature | | colspan="1" style="width: 300px;" | | ||
*Bradycardia<ref name="pmid8945708">{{cite journal| author=Ostergaard L, Huniche B, Andersen PL| title=Relative bradycardia in infectious diseases. | journal=J Infect | year= 1996 | volume= 33 | issue= 3 | pages= 185-91 | pmid=8945708 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8945708 }} </ref> | *Step-wise increase in temperature | ||
| colspan="1" style="width: 300px;" | *High grade fever which plateaus around 40°C | *[[Bradycardia]]<ref name="pmid8945708">{{cite journal| author=Ostergaard L, Huniche B, Andersen PL| title=Relative bradycardia in infectious diseases. | journal=J Infect | year= 1996 | volume= 33 | issue= 3 | pages= 185-91 | pmid=8945708 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8945708 }} </ref> | ||
| colspan="1" style="width: 300px;" | *Rising pulse | | colspan="1" style="width: 300px;" | | ||
*Falling blood pressure (shock) | *High grade [[fever]] which plateaus around 40°C | ||
| colspan="1" style="width: 300px;" | | |||
*Rising [[pulse]] | |||
*[[Falling blood pressure]] (shock) | |||
*Decreased or increased temperature<ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | *Decreased or increased temperature<ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Skin | ! rowspan="1" | Skin | ||
| colspan="1" style="width: 300px;" | *Normal to mild pallor | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Pallor++ | *Normal to mild [[pallor]] | ||
*Blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients) | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Pallor+++ (intestinal bleeding)<ref name="pmid26901611">{{cite journal| author=Akbayram S, Parlak M, Dogan M, Karasin G, Akbayram HT, Karaman KT| title=Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey. | journal=West Indian Med J | year= 2016 | volume= 65 | issue= 1 | pages= | pmid=26901611 | doi=10.7727/wimj.2014.354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26901611 }} </ref> | *Pallor++ | ||
* | *Blanching [[erythematous]] [[maculopapular]] [[lesions]] on the lower chest and abdomen (1/3 patients) | ||
| colspan="1" style="width: 300px;" | | |||
*Pallor+++ ([[intestinal bleeding]])<ref name="pmid26901611">{{cite journal| author=Akbayram S, Parlak M, Dogan M, Karasin G, Akbayram HT, Karaman KT| title=Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey. | journal=West Indian Med J | year= 2016 | volume= 65 | issue= 1 | pages= | pmid=26901611 | doi=10.7727/wimj.2014.354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26901611 }} </ref> | |||
*[[Bruises]] (DIC) | |||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | HEENT | ! rowspan="1" | HEENT | ||
| colspan="1" style="width: 300px;" |* Mild dehydration | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Lymphadenopathy | *Mild [[dehydration]] | ||
*Conjuctival pallor | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Sunken eyes | *[[Lymphadenopathy]] | ||
*Dry skin | *Conjuctival [[pallor]] | ||
| colspan="1" style="width: 300px;" | | |||
*Sunken eyes | |||
*[[Dry skin]] | |||
*Coated dry tongue | *Coated dry tongue | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | CV | ! rowspan="1" | CV | ||
| colspan="1" style="width: 300px;" | *Bradycardia | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Bradycardia | *[[Bradycardia]] | ||
| colspan="1" style="width: 300px;" | *Irregular rate | | colspan="1" style="width: 300px;" | | ||
*Rhythm and murmers (myocarditis)<ref name="pmid26730299">{{cite journal| author=Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT| title=Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. | journal=World J Cardiol | year= 2015 | volume= 7 | issue= 12 | pages= 931-7 | pmid=26730299 | doi=10.4330/wjc.v7.i12.931 | pmc=4691820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26730299 }} </ref> | *[[Bradycardia]] | ||
| colspan="1" style="width: 300px;" | | |||
*Irregular rate | |||
*Rhythm and murmers ([[myocarditis]])<ref name="pmid26730299">{{cite journal| author=Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT| title=Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. | journal=World J Cardiol | year= 2015 | volume= 7 | issue= 12 | pages= 931-7 | pmid=26730299 | doi=10.4330/wjc.v7.i12.931 | pmc=4691820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26730299 }} </ref> | |||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Pulmonary | ! rowspan="1" | Pulmonary | ||
| colspan="1" style="width: 300px;" | *Normal | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Ronchi(few) | *Normal | ||
| colspan="1" style="width: 300px;" | *Crepitations (pneumonia) | | colspan="1" style="width: 300px;" | | ||
*Ronchi (few) | |||
| colspan="1" style="width: 300px;" | | |||
*[[Crepitations]] ([[pneumonia]]) | |||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Abdomen | ! rowspan="1" | Abdomen | ||
| colspan="1" style="width: 300px;" |*Normal to mild tenderness | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Abdominal tenderness++ | *Normal to mild tenderness | ||
| colspan="1" style="width: 300px;" | | |||
*Abdominal tenderness++ | |||
*Abdominal distension+ | *Abdominal distension+ | ||
| colspan="1" style="width: 300px;" | *Tenderness+++(right lower quadrant) | | colspan="1" style="width: 300px;" | | ||
*Hepatosplenomegaly | *Tenderness+++ (right lower quadrant) | ||
*Absent bowel sounds (peritonitis)<ref name="pmid22357703">{{cite journal| author=Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD et al.| title=A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= 1091-9 | pmid=22357703 | doi=10.1093/cid/cis025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357703 }} </ref><ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | *[[Hepatosplenomegaly]] | ||
*Absent bowel sounds ([[peritonitis]])<ref name="pmid22357703">{{cite journal| author=Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD et al.| title=A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= 1091-9 | pmid=22357703 | doi=10.1093/cid/cis025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357703 }} </ref><ref name="pmid6361558">{{cite journal| author=Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR et al.| title=Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. | journal=N Engl J Med | year= 1984 | volume= 310 | issue= 2 | pages= 82-8 | pmid=6361558 | doi=10.1056/NEJM198401123100203 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6361558 }} </ref> | |||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Neurological | ! rowspan="1" | Neurological | ||
| colspan="1" style="width: 300px;" | *Alert and oriented | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Altered level of consciousness | *Alert and oriented | ||
| colspan="1" style="width: 300px;" | *Delirium or agitation | | colspan="1" style="width: 300px;" | | ||
*Neck stiffness (meningitis) | *Altered level of consciousness | ||
| colspan="1" style="width: 300px;" | | |||
*Delirium or agitation | |||
*Neck stiffness ([[meningitis]]) | |||
*Rigidity<ref name="pmid22357702">{{cite journal| author=Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS et al.| title=Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= 1100-6 | pmid=22357702 | doi=10.1093/cid/cis012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357702 }} </ref> | *Rigidity<ref name="pmid22357702">{{cite journal| author=Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS et al.| title=Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= 1100-6 | pmid=22357702 | doi=10.1093/cid/cis012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22357702 }} </ref> | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Musculoskeletal | ! rowspan="1" | Musculoskeletal | ||
| colspan="1" style="width: 300px;" | *Normal | | colspan="1" style="width: 300px;" | | ||
| colspan="1" style="width: 300px;" | *Mild muscle or joint tenderness | *Normal | ||
| colspan="1" style="width: 300px;" | *Joint swelling and tenderness | | colspan="1" style="width: 300px;" | | ||
*Mild muscle or joint tenderness | |||
| colspan="1" style="width: 300px;" | | |||
*Joint swelling and tenderness | |||
|} | |} | ||
Line 88: | Line 113: | ||
[[Category:Infectious diseases]] | [[Category:Infectious diseases]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] |
Latest revision as of 02:41, 18 July 2021
Typhoid fever Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Typhoid fever physical examination On the Web |
American Roentgen Ray Society Images of Typhoid fever physical examination |
Risk calculators and risk factors for Typhoid fever physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]
Overview
Common physical examination findings of typhoid fever include stepwise increase in temperature, bradycardia,[1] abdominal tenderness, and hepatosplenomegaly initially. In the third week of illness the patient may present with signs of complications.[2][3] Physical examination findings are dependent upon the timing of presentation.
Physical examination
Common physical examination findings of typhoid fever are described in the following table:[2][3]
Organ System | First Week | Second Week[4] | Third Week |
---|---|---|---|
General Appearance |
|
|
|
Vital signs |
|
|
|
Skin |
|
|
|
HEENT |
|
|
|
CV |
| ||
Pulmonary |
|
|
|
Abdomen |
|
|
|
Neurological |
|
|
|
Musculoskeletal |
|
|
|
References
- ↑ 1.0 1.1 Ostergaard L, Huniche B, Andersen PL (1996). "Relative bradycardia in infectious diseases". J Infect. 33 (3): 185–91. PMID 8945708.
- ↑ 2.0 2.1 Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.
- ↑ 3.0 3.1 Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA (2015). "Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever". J Glob Health. 5 (2): 020407. doi:10.7189/jogh.05.020407. PMC 4672836. PMID 26649174.
- ↑ 4.0 4.1 Neil KP, Sodha SV, Lukwago L, O-Tipo S, Mikoleit M, Simington SD; et al. (2012). "A large outbreak of typhoid fever associated with a high rate of intestinal perforation in Kasese District, Uganda, 2008-2009". Clin Infect Dis. 54 (8): 1091–9. doi:10.1093/cid/cis025. PMID 22357703.
- ↑ 5.0 5.1 5.2 Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR; et al. (1984). "Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone". N Engl J Med. 310 (2): 82–8. doi:10.1056/NEJM198401123100203. PMID 6361558.
- ↑ Akbayram S, Parlak M, Dogan M, Karasin G, Akbayram HT, Karaman KT (2016). "Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey". West Indian Med J. 65 (1). doi:10.7727/wimj.2014.354. PMID 26901611.
- ↑ Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT (2015). "Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis". World J Cardiol. 7 (12): 931–7. doi:10.4330/wjc.v7.i12.931. PMC 4691820. PMID 26730299.
- ↑ Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS; et al. (2012). "Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border". Clin Infect Dis. 54 (8): 1100–6. doi:10.1093/cid/cis012. PMID 22357702.