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==Overview==
==Overview==
==History==
==History==
*Obtaining history is the most important aspect of making a diagnosis of typhoid fever.
*It provides insight into cause, risk factors, and associated comorbid conditions.
*Complete history will help determine the correct therapy and helps in determining the prognosis.
*Symptomatic presentation of the patient depends mainly on the clinical stage of typhoid fever.
*Key points in history which can lead to diagnosis of typhoid fever include
:*Residence in endemic area
:*Recent travel history to endemic area
:*Recent use of antibiotics, antacids or proton pump inhibitors
:*Medical conditions causing acchlorydia such as pernicious anemia
:*History of immunosuppressive illness such as AIDS
:*Poor hygiene and sanitation conditions
:*Contact history with person already having typhoid
:*Occupational history such as health care workers and laboratory personnel handling ''[[Salmonella typhi]]''.
:* Past history showing cystic fibrosis and haemachromatosis may help rule out typhoid fever.
:*Symptoms showing febrile illness with typical stepwise rise in temperature with non specific abdominal complaints and other constitutional symptoms such as malaise, headache and rash.
==Symptoms==  
==Symptoms==  
Symptoms of typhoid fever include the following:<ref name="pmid2017639">{{cite journal| author=Butler T, Islam A, Kabir I, Jones PK| title=Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. | journal=Rev Infect Dis | year= 1991 | volume= 13 | issue= 1 | pages= 85-90 | pmid=2017639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2017639  }} </ref><ref name="pmid20278487">{{cite journal| author=STUART BM, PULLEN RL| title=Typhoid; clinical analysis of 360 cases. | journal=Arch Intern Med (Chic) | year= 1946 | volume= 78 | issue= 6 | pages= 629-61 | pmid=20278487 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20278487  }} </ref><ref> {{cite web|url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm |title=CDC Typhoid Fever |accessdate=2007-10-02 |date=2005-10-25 |publisher=Center for Disease Control }}</ref><ref name="pmid1899554">{{cite journal| author=Gotuzzo E, Frisancho O, Sanchez J, Liendo G, Carrillo C, Black RE et al.| title=Association between the acquired immunodeficiency syndrome and infection with Salmonella typhi or Salmonella paratyphi in an endemic typhoid area. | journal=Arch Intern Med | year= 1991 | volume= 151 | issue= 2 | pages= 381-2 | pmid=1899554 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1899554  }} </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><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><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><ref>Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.</ref><ref name="pmid15673941">{{cite journal| author=Pohan HT| title=Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta. | journal=Acta Med Indones | year= 2004 | volume= 36 | issue= 2 | pages= 78-83 | pmid=15673941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15673941  }} </ref><ref name="pmid23284780">{{cite journal| author=Thriemer K, Ley B, Ley BB, Ame SS, Deen JL, Pak GD et al.| title=Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions. | journal=PLoS One | year= 2012 | volume= 7 | issue= 12 | pages= e51823 | pmid=23284780 | doi=10.1371/journal.pone.0051823 | pmc=3527440 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23284780  }} </ref><ref name="pmid9465434">{{cite journal| author=Haq SA, Alam MN, Hossain SM, Ahmed T, Tahir M| title=Value of clinical features in the diagnosis of enteric fever. | journal=Bangladesh Med Res Counc Bull | year= 1997 | volume= 23 | issue= 2 | pages= 42-6 | pmid=9465434 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9465434  }} </ref>     
Symptoms of typhoid fever include the following:<ref name="pmid2017639">{{cite journal| author=Butler T, Islam A, Kabir I, Jones PK| title=Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. | journal=Rev Infect Dis | year= 1991 | volume= 13 | issue= 1 | pages= 85-90 | pmid=2017639 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2017639  }} </ref><ref name="pmid20278487">{{cite journal| author=STUART BM, PULLEN RL| title=Typhoid; clinical analysis of 360 cases. | journal=Arch Intern Med (Chic) | year= 1946 | volume= 78 | issue= 6 | pages= 629-61 | pmid=20278487 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20278487  }} </ref><ref> {{cite web|url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm |title=CDC Typhoid Fever |accessdate=2007-10-02 |date=2005-10-25 |publisher=Center for Disease Control }}</ref><ref name="pmid1899554">{{cite journal| author=Gotuzzo E, Frisancho O, Sanchez J, Liendo G, Carrillo C, Black RE et al.| title=Association between the acquired immunodeficiency syndrome and infection with Salmonella typhi or Salmonella paratyphi in an endemic typhoid area. | journal=Arch Intern Med | year= 1991 | volume= 151 | issue= 2 | pages= 381-2 | pmid=1899554 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1899554  }} </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><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><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><ref>Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.</ref><ref name="pmid15673941">{{cite journal| author=Pohan HT| title=Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta. | journal=Acta Med Indones | year= 2004 | volume= 36 | issue= 2 | pages= 78-83 | pmid=15673941 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15673941  }} </ref><ref name="pmid23284780">{{cite journal| author=Thriemer K, Ley B, Ley BB, Ame SS, Deen JL, Pak GD et al.| title=Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions. | journal=PLoS One | year= 2012 | volume= 7 | issue= 12 | pages= e51823 | pmid=23284780 | doi=10.1371/journal.pone.0051823 | pmc=3527440 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23284780  }} </ref><ref name="pmid9465434">{{cite journal| author=Haq SA, Alam MN, Hossain SM, Ahmed T, Tahir M| title=Value of clinical features in the diagnosis of enteric fever. | journal=Bangladesh Med Res Counc Bull | year= 1997 | volume= 23 | issue= 2 | pages= 42-6 | pmid=9465434 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9465434  }} </ref>     

Revision as of 14:49, 29 August 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

History

  • Obtaining history is the most important aspect of making a diagnosis of typhoid fever.
  • It provides insight into cause, risk factors, and associated comorbid conditions.
  • Complete history will help determine the correct therapy and helps in determining the prognosis.
  • Symptomatic presentation of the patient depends mainly on the clinical stage of typhoid fever.
  • Key points in history which can lead to diagnosis of typhoid fever include
  • Residence in endemic area
  • Recent travel history to endemic area
  • Recent use of antibiotics, antacids or proton pump inhibitors
  • Medical conditions causing acchlorydia such as pernicious anemia
  • History of immunosuppressive illness such as AIDS
  • Poor hygiene and sanitation conditions
  • Contact history with person already having typhoid
  • Occupational history such as health care workers and laboratory personnel handling Salmonella typhi.
  • Past history showing cystic fibrosis and haemachromatosis may help rule out typhoid fever.
  • Symptoms showing febrile illness with typical stepwise rise in temperature with non specific abdominal complaints and other constitutional symptoms such as malaise, headache and rash.

Symptoms

Symptoms of typhoid fever include the following:[1][2][3][4][5][5][6][7][8][9][10]

Most common symptoms

  • Stepledder increase in temperature initially and than sustained fever as high as 40°C (104°F)[2]
  • Profuse sweating
  • Influenza-like symptoms with chills
  • Malaise
  • headache[5]
  • Poorly localised abdominal pain[8]
  • Diarrhea[11]
  • Constipation
  • Loss of apatite
  • Nausea[8]

Less common symptoms

  • Rash causing flat, rose-colored spots [12]

Course of typhoid fever

Typhoid fever symptoms can be divided into four individual stages, each lasting approximately one week.

First week

  • Slowly rising temperature with relative bradycardia,
  • malaise
  • headache
  • cough.
  • Epistaxis
  • abdominal pain

Second week

  • Prostration
  • High grade fever which plateaus around 40°C
  • Bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave.
  • Delirium or agitation (nervous fever)
  • Rose spots on the lower chest and abdomen(1/3 patients).
  • Rhonchi in lung bases.
  • Painful abdomen(right lower quadrant).
  • Diarrhea (six to eight stools/day), green with a characteristic smell, comparable to pea-soup.[4]
  • Constipation

Third week

References

  1. ↑ Butler T, Islam A, Kabir I, Jones PK (1991). "Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea". Rev Infect Dis. 13 (1): 85–90. PMID 2017639.
  2. ↑ 2.0 2.1 STUART BM, PULLEN RL (1946). "Typhoid; clinical analysis of 360 cases". Arch Intern Med (Chic). 78 (6): 629–61. PMID 20278487.
  3. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
  4. ↑ 4.0 4.1 Gotuzzo E, Frisancho O, Sanchez J, Liendo G, Carrillo C, Black RE; et al. (1991). "Association between the acquired immunodeficiency syndrome and infection with Salmonella typhi or Salmonella paratyphi in an endemic typhoid area". Arch Intern Med. 151 (2): 381–2. PMID 1899554.
  5. ↑ 5.0 5.1 5.2 5.3 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.
  6. ↑ 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.
  7. ↑ Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.
  8. ↑ 8.0 8.1 8.2 Pohan HT (2004). "Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta". Acta Med Indones. 36 (2): 78–83. PMID 15673941.
  9. ↑ Thriemer K, Ley B, Ley BB, Ame SS, Deen JL, Pak GD; et al. (2012). "Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions". PLoS One. 7 (12): e51823. doi:10.1371/journal.pone.0051823. PMC 3527440. PMID 23284780.
  10. ↑ Haq SA, Alam MN, Hossain SM, Ahmed T, Tahir M (1997). "Value of clinical features in the diagnosis of enteric fever". Bangladesh Med Res Counc Bull. 23 (2): 42–6. PMID 9465434.
  11. ↑ Butler, Thomas, et al. "Patterns of Morbidity and Mortality in Typhoid Fever Dependent on Age and Gender: Review of 552 Hopitalized Patients with Diarrhea." Review of Infectious Diseases 13.1 (1991): 85-90.
  12. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.

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