Typhoid fever history and symptoms

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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[1][2][3][4][5]
  • Residence in endemic area
  • Recent travel history to endemic area[6]
  • 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.[7][8][9]
  • 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.[10]

Symptoms

Symptoms of typhoid fever include the following:[11][12][13][14][15][15][16][17][18][19][20]

Most common symptoms

  • Stepledder increase in temperature initially and than sustained fever as high as 40°C (104°F)[12]
  • Profuse sweating
  • Influenza-like symptoms with chills
  • Malaise
  • headache[15]
  • Poorly localised abdominal pain[18]
  • Diarrhea[21]
  • Constipation
  • Loss of apatite
  • Nausea[18]

Less common symptoms

  • Rash causing flat, rose-colored spots [22]

Course of typhoid fever

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


First Week Second Week Third Week
  • 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.[14]
  • Constipation

References

  1. ↑ Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA; et al. (1998). "Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan". Epidemiol Infect. 120 (2): 129–38. PMC 2809381. PMID 9593481.
  2. ↑ Marshall E, Howells RE (1986). "Turnover of the surface proteins of adult and third and fourth stage larval Brugia pahangi". Mol Biochem Parasitol. 18 (1): 17–24. PMID 2870432.
  3. ↑ Srikantiah P, Vafokulov S, Luby SP, Ishmail T, Earhart K, Khodjaev N; et al. (2007). "Epidemiology and risk factors for endemic typhoid fever in Uzbekistan". Trop Med Int Health. 12 (7): 838–47. doi:10.1111/j.1365-3156.2007.01853.x. PMID 17596250.
  4. ↑ Mermin, Jonathan H., et al. "A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water." Journal of Infectious Diseases 179.6 (1999): 1416-1422.
  5. ↑ Black, Robert E., et al. "Case—control study to identify risk factors for paediatric endemic typhoid fever in Santiago, Chile." Bulletin of the World Health Organization 63.5 (1985): 899.
  6. ↑ Ekdahl, Karl, Birgitta de Jong, and Yvonne Andersson. "Risk of travel-associated typhoid and paratyphoid fevers in various regions." Journal of travel medicine 12.4 (2005): 197-204.
  7. ↑ Weinberg ED (2008). "Survival advantage of the hemochromatosis C282Y mutation". Perspect Biol Med. 51 (1): 98–102. doi:10.1353/pbm.2008.0001. PMID 18192769.
  8. ↑ Moalem S, Weinberg ED, Percy ME (2004). "Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival". Biometals. 17 (2): 135–9. PMID 15088940.
  9. ↑ van de Vosse E, de Visser AW, Al-Attar S, Vossen R, Ali S, van Dissel JT (2010). "Distribution of CFTR variations in an Indonesian enteric fever cohort". Clin Infect Dis. 50 (9): 1231–7. doi:10.1086/651598. PMID 20233062.
  10. ↑ Christie AB. Infectious Diseases, Epidemiology and Clinical Practice. Edinburgh; Churchill Livingstone, 1987
  11. ↑ 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.
  12. ↑ 12.0 12.1 STUART BM, PULLEN RL (1946). "Typhoid; clinical analysis of 360 cases". Arch Intern Med (Chic). 78 (6): 629–61. PMID 20278487.
  13. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.
  14. ↑ 14.0 14.1 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.
  15. ↑ 15.0 15.1 15.2 15.3 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 18.0 18.1 18.2 Pohan HT (2004). "Clinical and laboratory manifestations of typhoid fever at Persahabatan Hospital, Jakarta". Acta Med Indones. 36 (2): 78–83. PMID 15673941.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ "CDC Typhoid Fever". Center for Disease Control. 2005-10-25. Retrieved 2007-10-02.

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