Typhoid fever physical examination: Difference between revisions

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! Second Week<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>
! Second Week<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>
! Third Week
! Third Week
! rowspan="1" | Vital signs
| colspan="1" style="width: 400px;" | Slowly rising temperature with relative bradycardia
| colspan="1" style="width: 400px;" | High grade fever which plateaus around 40°C
| colspan="1" style="width: 400px;" | Bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave.
|- valign="top"
|- valign="top"
|- valign="top"
! rowspan="1" | General Appearance
! rowspan="1" | General Appearance
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| colspan="1" style="width: 400px;" | Patient is in acute distress
| colspan="1" style="width: 400px;" | Patient is in acute distress
| colspan="1" style="width: 400px;" | Patient is in severe distress  
| colspan="1" style="width: 400px;" | Patient is in severe distress  
|- valign="top"
! rowspan="1" | Vital signs
| colspan="1" style="width: 400px;" | Normal to mild pallor
| colspan="1" style="width: 400px;" | Pallor++, rose spots on the lower chest and abdomen(1/3 patients) 
| colspan="1" style="width: 400px;" | Pallor+++
|- valign="top"
|- valign="top"
! rowspan="1" | Skin
! rowspan="1" | Skin
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|- valign="top"
|- valign="top"
! rowspan="1" | CV
! rowspan="1" | CV
| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | Bradycardia
| colspan="1" style="width: 400px;" | Second week findings
| colspan="1" style="width: 400px;" | Bradycardia
| colspan="1" style="width: 400px;" | Third week findings
| colspan="1" style="width: 400px;" | Irregular rate and rhythm murmers(myocarditis)
|- valign="top"
|- valign="top"
! rowspan="1" | Pulmonary
! rowspan="1" | Pulmonary
| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | Second week findings  
| colspan="1" style="width: 400px;" | Second week findings  
| colspan="1" style="width: 400px;" | Third week findings
| colspan="1" style="width: 400px;" | crepitations(Pneumonia)
|- valign="top"
|- valign="top"
! rowspan="1" | Abdomen
! rowspan="1" | Abdomen
| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | Abdominal tenderness+
| colspan="1" style="width: 400px;" | Second week findings
| colspan="1" style="width: 400px;" | Abdominal tenderness++
| colspan="1" style="width: 400px;" | Tenderness++, absent bowel sounds  
| colspan="1" style="width: 400px;" | Tenderness+++, absent bowel sounds (peritonitis)
|- valign="top"
|- valign="top"
! rowspan="1" | Neurological
! rowspan="1" | Neurological
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| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | First week findings
| colspan="1" style="width: 400px;" | Second week findings  
| colspan="1" style="width: 400px;" | Second week findings  
| colspan="1" style="width: 400px;" | Third week findings
| colspan="1" style="width: 400px;" | Joint swelling and tenderness
|}
|}



Revision as of 19:38, 31 August 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

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 Normal to mild pallor Pallor++, rose spots on the lower chest and abdomen(1/3 patients) Pallor+++
Skin Normal to mild pallor Pallor++, rose spots on the lower chest and abdomen(1/3 patients) Pallor+++
HEENT Second week findings Third week findings
CV Bradycardia Bradycardia Irregular rate and rhythm murmers(myocarditis)
Pulmonary First week findings Second week findings crepitations(Pneumonia)
Abdomen Abdominal tenderness+ Abdominal tenderness++ Tenderness+++, absent bowel sounds (peritonitis)
Neurological First week findings Second week findings Delirium or agitation
Musculoskeletal First week findings Second week findings Joint swelling and tenderness
  • 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


References

  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.
  2. 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.
  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.

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