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
  • 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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