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{{Typhoid fever}}
{{Typhoid fever}}
 
{{CMG}}; {{AE}} {{AAA}}
{{CMG}}; {{AE}}{{AA}}


== Overview ==
== Overview ==
Common physical examination findings of typhoid fever include 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> [[abdominal tenderness]], and [[hepatosplenomegaly]] initially. In the third week of illness the patient may present with signs of complications.<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> Physical examination findings are dependent upon the timing of presentation.


== Physical examination ==
== Physical examination ==
Common physical examination findings of [[typhoid fever]] 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"
Line 17: Line 17:
|- valign="top"
|- valign="top"
! rowspan="1" | General Appearance
! rowspan="1" | General Appearance
| colspan="1" style="width: 500px;" | Patient may be in mild distress
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 500px;" | Patient is in acute distress
*Mild distress
| colspan="1" style="width: 500px;" | Patient is in severe distress
| colspan="1" style="width: 300px;" |  
*Acute distress
| colspan="1" style="width: 300px;" |  
*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: 300px;" |  
| colspan="1" style="width: 500px;" | High grade fever which plateaus around 40°C
*Step-wise increase in temperature  
| colspan="1" style="width: 500px;" | Rising pulse, and falling blood pressure (shock)
*[[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: 300px;" |  
*High grade [[fever]] which plateaus around 40°C
| colspan="1" style="width: 300px;" |  
*Rising [[pulse]]
*[[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: 300px;" |  
| colspan="1" style="width: 500px;" | Pallor++, rose spots on the lower chest and abdomen(1/3 patients)   
*Normal to mild [[pallor]]
| colspan="1" style="width: 500px;" | Pallor+++
| colspan="1" style="width: 300px;" |
*Pallor++  
*Blanching [[erythematous]] [[maculopapular]] [[lesions]] on the lower chest and abdomen (1/3 patients)   
| colspan="1" style="width: 300px;" |  
*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;" |  
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 500px;" | coated dry tongue,
*Mild [[dehydration]]
| colspan="1" style="width: 500px;" | Third week findings
| colspan="1" style="width: 300px;" |
*[[Lymphadenopathy]]
*Conjuctival [[pallor]]
| colspan="1" style="width: 300px;" |  
*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: 300px;" |  
| colspan="1" style="width: 500px;" | Bradycardia
*[[Bradycardia]]
| colspan="1" style="width: 500px;" | Irregular rate and rhythm murmers(myocarditis)
| colspan="1" style="width: 300px;" |  
*[[Bradycardia]]
| colspan="1" style="width: 300px;" |  
*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: 300px;" |  
| colspan="1" style="width: 500px;" | Second week findings
*Normal
| colspan="1" style="width: 500px;" | Crepitations(Pneumonia)
| colspan="1" style="width: 300px;" |  
*Ronchi (few)
| colspan="1" style="width: 300px;" |  
*[[Crepitations]] ([[pneumonia]])
|- valign="top"
|- valign="top"
! rowspan="1" | Abdomen
! rowspan="1" | Abdomen
| colspan="1" style="width: 500px;" | Abdominal tenderness+
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 500px;" | Abdominal tenderness++, distension+
*Normal to mild tenderness
| colspan="1" style="width: 500px;" | Tenderness+++, hepatosplenomegaly, absent bowel sounds (peritonitis)
| colspan="1" style="width: 300px;" |  
*Abdominal tenderness++  
*Abdominal distension+
| colspan="1" style="width: 300px;" |
*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><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" | Neurological
! rowspan="1" | Neurological
| colspan="1" style="width: 500px;" | First week findings
| colspan="1" style="width: 300px;" |
| colspan="1" style="width: 500px;" | Altered level of consciousness  
*Alert and oriented
| colspan="1" style="width: 500px;" | Delirium or agitation  
| colspan="1" style="width: 300px;" |  
*Altered level of consciousness  
| colspan="1" style="width: 300px;" |  
*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
| colspan="1" style="width: 500px;" | First week findings
| colspan="1" style="width: 300px;" |  
| colspan="1" style="width: 500px;" | Second week findings
*Normal
| colspan="1" style="width: 500px;" | Joint swelling and tenderness
| colspan="1" style="width: 300px;" |  
*Mild muscle or joint tenderness
| colspan="1" style="width: 300px;" |  
*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.<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 
*Intestinal hemorrhage
*Intestinal perforation in distal [[ileum]](Fatal)
*[[Septicaemia]] or diffuse [[peritonitis]]<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> 
*[[Encephalitis]]
*Metastatic abscesses
*[[Cholecystitis]]
*[[Endocarditis]]
*Osteitis
*Defervescence


== References ==
== References ==
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[[Category:Infectious diseases]]
[[Category:Infectious diseases]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]

Latest revision as of 02:41, 18 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Overview

Common physical examination findings of typhoid fever include stepwise increase in temperature, bradycardia,[1] abdominal tenderness, and hepatosplenomegaly initially. In the third week of illness the patient may present with signs of complications.[2][3] Physical examination findings are dependent upon the timing of presentation.

Physical examination

Common physical examination findings of typhoid fever are described in the following table:[2][3]

Organ System First Week Second Week[4] Third Week
General Appearance
  • Mild distress
  • Acute distress
Vital signs
  • High grade fever which plateaus around 40°C
Skin
HEENT
CV
Pulmonary
  • Normal
  • Ronchi (few)
Abdomen
  • Normal to mild tenderness
  • Abdominal tenderness++
  • Abdominal distension+
Neurological
  • Alert and oriented
  • Altered level of consciousness
Musculoskeletal
  • Normal
  • Mild muscle or joint tenderness
  • Joint swelling and tenderness

References

  1. ↑ 1.0 1.1 Ostergaard L, Huniche B, Andersen PL (1996). "Relative bradycardia in infectious diseases". J Infect. 33 (3): 185–91. PMID 8945708.
  2. ↑ 2.0 2.1 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.
  3. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 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.
  5. ↑ 5.0 5.1 5.2 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.

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