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]
Overview
Physical examination
| Organ System | First Week | Second Week[1] | 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 | Lymphadenopathy | Coated dry tongue, | sunken eyes, dry skin |
| 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.[2]
- Constipation
- Intestinal hemorrhage
- Intestinal perforation in distal ileum(Fatal)
- Septicaemia or diffuse peritonitis[3]
- Encephalitis
- Metastatic abscesses
- Cholecystitis
- Endocarditis
- Osteitis
- Defervescence
References
- ↑ 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.
- ↑ 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.
- ↑ 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.