Typhoid fever physical examination: Difference between revisions
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| colspan="1" style="width: 500px;" | Normal to mild pallor | | colspan="1" style="width: 500px;" | Normal to mild pallor | ||
| 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++, blanching erythematous maculopapular lesions on the lower chest and abdomen(1/3 patients) | ||
| colspan="1" style="width: 500px;" | Pallor+++ (intestinal bleeding) | | colspan="1" style="width: 500px;" | 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: 500px;" | Mild dehydration | | colspan="1" style="width: 500px;" | Mild dehydration | ||
| colspan="1" style="width: 500px;" | Lymphadenopathy, conjuctival pallor | | colspan="1" style="width: 500px;" | Lymphadenopathy, conjuctival pallor | ||
| colspan="1" style="width: 500px;" | | | colspan="1" style="width: 500px;" | Sunken eyes, dry skin, coated dry tongue | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | CV | ! rowspan="1" | CV | ||
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| colspan="1" style="width: 500px;" | Alert and oriented | | 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, 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> | ||
|- valign="top" | |- valign="top" | ||
! rowspan="1" | Musculoskeletal | ! rowspan="1" | Musculoskeletal | ||
Revision as of 14:54, 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),[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++, distension+ | Tenderness+++(right lower quadrant), hepatosplenomegaly, absent bowel sounds (peritonitis)[3] |
| 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 |
- Slowly rising temperature with relative bradycardia
- Malaise
- Headache
- Cough
- Epistaxis
- Abdominal pain
- Intestinal hemorrhage
- Intestinal perforation in distal ileum(Fatal)
- Septicaemia or diffuse peritonitis[4]
- Encephalitis
- Metastatic abscesses
- Cholecystitis
- Endocarditis
- Osteitis
- Defervescence
References
- ↑ 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.
- ↑ 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.
- ↑ 3.0 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.
- ↑ 4.0 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.
- ↑ Ostergaard L, Huniche B, Andersen PL (1996). "Relative bradycardia in infectious diseases". J Infect. 33 (3): 185–91. PMID 8945708.
- ↑ 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.