Typhoid fever physical examination

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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]

Physical examination

Organ System	First Week	Second Week	Third Week
General Appearance	Patient may be in mild distress	Patient is in acute distress	Patient is in severe distress
Vital signs	Increased temperature, bradycardia	High grade fever which plateaus around 40°C	Rising pulse, and falling blood pressure (shock)
Skin	Normal to mild pallor	Pallor++, rose spots on the lower chest and abdomen(1/3 patients)	Pallor+++
HEENT		coated dry tongue,	Third week findings
CV	Bradycardia	Bradycardia	Irregular rate and rhythm murmers(myocarditis)
Pulmonary	First week findings	Second week findings	Crepitations(Pneumonia)
Abdomen	Abdominal tenderness+	Abdominal tenderness++, distension+	Tenderness+++, hepatosplenomegaly, absent bowel sounds (peritonitis)
Neurological	First week findings	Altered level of consciousness	Delirium or agitation
Musculoskeletal	First week findings	Second week findings	Joint swelling and tenderness

• Slowly rising temperature with relative bradycardia
• Malaise
• Headache
• Cough
• Epistaxis
• Abdominal pain

• 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.
• Constipation

• Intestinal hemorrhage
• Intestinal perforation in distal ileum(Fatal)
• Septicaemia or diffuse peritonitis
• Encephalitis
• Metastatic abscesses
• Cholecystitis
• Endocarditis
• Osteitis
• Defervescence