Typhoid fever physical examination: Difference between revisions

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|- valign="top"
|- valign="top"
! rowspan="1" | General Appearance
! rowspan="1" | General Appearance
| colspan="1" style="width: 300px;" | *Patient may be in mild distress
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 300px;" | *Patient is in acute distress
*Patient may be in mild distress
| colspan="1" style="width: 300px;" | *Patient is in severe distress  
| colspan="1" style="width: 300px;" |  
*Patient is in acute distress
| colspan="1" style="width: 300px;" |  
*Patient is in 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>
*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;" |  
*Step-wise 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>
*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;" | *High grade fever which plateaus around 40°C
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 300px;" | *Rising pulse
*High grade fever which plateaus around 40°C
| colspan="1" style="width: 300px;" |  
*Rising pulse
*Falling blood pressure (shock)  
*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
| colspan="1" style="width: 300px;" |
*Pallor++  
*Blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients)   
*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>  
| 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)
*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
| colspan="1" style="width: 300px;" |
*Lymphadenopathy  
*Conjuctival pallor
*Conjuctival pallor
| colspan="1" style="width: 300px;" | *Sunken eyes  
| colspan="1" style="width: 300px;" |  
*Sunken eyes  
*Dry skin
*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;" |  
*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>
*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;" |
*Tenderness+++(right lower quadrant)
*Hepatosplenomegaly
*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>   
*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;" |  
*Altered level of consciousness  
| colspan="1" style="width: 300px;" |  
*Delirium or agitation  
*Neck stiffness (meningitis)  
*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
|}
|}


Revision as of 16:13, 1 September 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

Physical examination findings are described according to the timing of presentation. These include stepwise increase in temperature, bradycardia[1] abdominal tenderness, hepatosplenomegaly initially. In the third week of illness patient may present with signs showing complications.[2][3]

Physical examination

Physical examination findings are described in the following table[2][3]

Organ System First Week Second Week[4] Third Week
General Appearance
  • Patient may be in mild distress
  • Patient is in acute distress
  • Patient is in severe distress
  • Delirious or unconscious[5]
Vital signs
  • Step-wise increase in temperature
  • Bradycardia[1]
  • High grade fever which plateaus around 40°C
  • Rising pulse
  • Falling blood pressure (shock)
  • Decreased or increased temperature[5]
Skin
  • Normal to mild pallor
  • Pallor++
  • Blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients)
  • Pallor+++ (intestinal bleeding)[6]
  • bruises (DIC)
HEENT
  • Mild dehydration
  • Lymphadenopathy
  • Conjuctival pallor
  • Sunken eyes
  • Dry skin
  • Coated dry tongue
CV
  • Bradycardia
  • Bradycardia
  • Irregular rate
  • Rhythm and murmers (myocarditis)[7]
Pulmonary
  • Normal
  • Ronchi(few)
  • Crepitations (pneumonia)
Abdomen
  • Normal to mild tenderness
  • Abdominal tenderness++
  • Abdominal distension+
  • Tenderness+++(right lower quadrant)
  • Hepatosplenomegaly
  • Absent bowel sounds (peritonitis)[4][5]
Neurological
  • Alert and oriented
  • Altered level of consciousness
  • Delirium or agitation
  • Neck stiffness (meningitis)
  • Rigidity[8]
Musculoskeletal
  • Normal
  • Mild muscle or joint tenderness
  • Joint swelling and tenderness

References

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.

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