Typhoid fever physical examination: Difference between revisions

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== Physical examination ==
== Physical examination ==
Physical examination findings 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"
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| colspan="1" style="width: 500px;" | Patient may be in mild distress
| colspan="1" style="width: 500px;" | Patient may be in mild distress
| colspan="1" style="width: 500px;" | Patient is in acute distress
| colspan="1" style="width: 500px;" | Patient is in acute distress
| colspan="1" style="width: 500px;" | Patient is in severe distress  
| colspan="1" style="width: 500px;" | 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>
|- valign="top"
|- valign="top"
! rowspan="1" | Vital signs
! rowspan="1" | Vital signs
| colspan="1" style="width: 500px;" | Increased temperature, bradycardia
| colspan="1" style="width: 500px;" | 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>
| colspan="1" style="width: 500px;" | High grade fever which plateaus around 40°C
| colspan="1" style="width: 500px;" | High grade fever which plateaus around 40°C
| colspan="1" style="width: 500px;" | Rising pulse, and falling blood pressure (shock)
| colspan="1" style="width: 500px;" | Rising pulse, and 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>
|- valign="top"
|- valign="top"
! rowspan="1" | Skin
! rowspan="1" | Skin
| colspan="1" style="width: 500px;" | Normal to mild pallor
| colspan="1" style="width: 500px;" | Normal to mild pallor
| colspan="1" style="width: 500px;" | Pallor++, rose spots on the lower chest and abdomen(1/3 patients)   
| colspan="1" style="width: 500px;" | Pallor++, blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients)   
| colspan="1" style="width: 500px;" | Pallor+++
| colspan="1" style="width: 500px;" | Pallor+++ (intestinal bleeding)
|- valign="top"
|- valign="top"
! rowspan="1" | HEENT
! rowspan="1" | HEENT
| colspan="1" style="width: 500px;" | Lymphadenopathy
| colspan="1" style="width: 500px;" | Mild dehydration
| colspan="1" style="width: 500px;" | Coated dry tongue,  
| colspan="1" style="width: 500px;" | Lymphadenopathy, conjuctival pallor
| colspan="1" style="width: 500px;" | sunken eyes, dry skin
| colspan="1" style="width: 500px;" | sunken eyes dry skin, coated dry tongue,
|- valign="top"
|- valign="top"
! rowspan="1" | CV
! rowspan="1" | CV
| colspan="1" style="width: 500px;" | Bradycardia
| colspan="1" style="width: 500px;" | Bradycardia
| colspan="1" style="width: 500px;" | Bradycardia
| colspan="1" style="width: 500px;" | Bradycardia
| colspan="1" style="width: 500px;" | Irregular rate and rhythm murmers(myocarditis)
| colspan="1" style="width: 500px;" | 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: 500px;" | First week findings
| colspan="1" style="width: 500px;" | Normal
| colspan="1" style="width: 500px;" | Second week findings
| colspan="1" style="width: 500px;" | Ronchi(few)
| colspan="1" style="width: 500px;" | Crepitations(Pneumonia)
| colspan="1" style="width: 500px;" | Crepitations (Pneumonia)
|- valign="top"
|- valign="top"
! rowspan="1" | Abdomen
! rowspan="1" | Abdomen
| colspan="1" style="width: 500px;" | Abdominal tenderness+
| colspan="1" style="width: 500px;" | Normal to mild tenderness
| colspan="1" style="width: 500px;" | Abdominal tenderness++, distension+
| colspan="1" style="width: 500px;" | Abdominal tenderness++, distension+
| colspan="1" style="width: 500px;" | Tenderness+++, hepatosplenomegaly, absent bowel sounds (peritonitis)
| colspan="1" style="width: 500px;" | Tenderness+++(right lower quadrant), 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>
|- valign="top"
|- valign="top"
! rowspan="1" | Neurological
! rowspan="1" | Neurological
| colspan="1" style="width: 500px;" | First week findings
| colspan="1" style="width: 500px;" | Alert and oriented
| colspan="1" style="width: 500px;" | Altered level of consciousness  
| colspan="1" style="width: 500px;" | Altered level of consciousness  
| colspan="1" style="width: 500px;" | Delirium or agitation  
| colspan="1" style="width: 500px;" | Delirium or agitation  
|- valign="top"
|- valign="top"
! rowspan="1" | Musculoskeletal
! rowspan="1" | Musculoskeletal
| colspan="1" style="width: 500px;" | First week findings
| colspan="1" style="width: 500px;" | Normal
| colspan="1" style="width: 500px;" | Second week findings
| colspan="1" style="width: 500px;" | Mild muscle or joint tenderness
| colspan="1" style="width: 500px;" | Joint swelling and tenderness
| colspan="1" style="width: 500px;" | Joint swelling and tenderness
|}
|}
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*Abdominal pain   
*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.<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>
*Constipation 




Revision as of 14:28, 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

Physical examination findings are described in the following table[1][2]

Organ System First Week Second Week[3] Third Week
General Appearance Patient may be in mild distress Patient is in acute distress Patient is in severe distress, delirious or unconscious[4]
Vital signs Stepwise increase in temperature, bradycardia[5] High grade fever which plateaus around 40°C Rising pulse, and falling blood pressure (shock), decreased or increased temperature[4]
Skin Normal to mild pallor Pallor++, blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients) Pallor+++ (intestinal bleeding)
HEENT Mild dehydration Lymphadenopathy, conjuctival pallor sunken eyes dry skin, coated dry tongue,
CV Bradycardia Bradycardia Irregular rate, rhythm and murmers (myocarditis)[6]
Pulmonary Normal Ronchi(few) Crepitations (Pneumonia)
Abdomen Normal to mild tenderness Abdominal tenderness++, distension+ Tenderness+++(right lower quadrant), hepatosplenomegaly, absent bowel sounds (peritonitis)[3]
Neurological Alert and oriented Altered level of consciousness Delirium or agitation
Musculoskeletal Normal Mild muscle or joint tenderness Joint swelling and tenderness



References

  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.
  2. ↑ 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.
  3. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 4.2 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.
  5. ↑ Ostergaard L, Huniche B, Andersen PL (1996). "Relative bradycardia in infectious diseases". J Infect. 33 (3): 185–91. PMID 8945708.
  6. ↑ 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.

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