Typhoid Fever: Health Relevance Of Its Clinical Manifestations

The onset is slow with anorexia, malaise, lethargy, fever and headache. The temperature rises in a step-ladder pattern in the first week. The pulse is relatively slow. Headache is prominent from the beginning. Since the temperature is continuous, chills and rigor do not occur in the untreated case. Epistaxis may occur as a prodromal symptom. Non- productive cough may be present in a few cases. Abdominal symptoms such as vague discomfort, pain, constipation and less often diarrhea are present in the majority of cases. Physical examination is the first week reveals slow-pulse fever, abdominal distension and tenderness. Erythematous macules called “rose spots” appear over the upper abdomen and chest. These are 2 to 3 mm in diameter and are due to bacterial embolism. They last for a few days and fade off. It is difficult to find them in dark- skinned individuals.

In the second week, the temperature increases and remains continuous around 40⁰C with relative bradycardia. The patient may become dehydrated, delirious and exhausted. The tongue is coated in the center with the margins remaining reddish and this finding is very suggestive of enteric fevers, though this is not a specific sign. The signs of toxemia become manifest and the total picture is referred to as the “typhoid state”. In this stage, the patient shows muttering delirium, tremulousness of the hands (subsultus tendinum), carphalogy (picking movements of the hands) and coma vigil (the patient is comatose but his eyes are open). Abdomen is moderated distended (timidity) with vague tenderness, especially over the right iliac fossa. Palpation may reveal gurgling due to mild distension of ileal loops. Over 75% of cases show moderate splenomegaly (3 ot 4 cm) and the organ is soft.

Complications such as intestinal perforation and peritonitis are rare in the second week but marked abdominal rigidity and tenderness should suggest this possibility. The stools are described as pea-soup stools since feces are losse and greenish in colour. It may contain blood streaks. Fever and toxemia continue in the third week of the illness; the major complications set in during this period.

In uncomplicated cases, the temperature starts to fall by lysis at the end of the third week and it touches normal within 7 to 10 days. The abdominal symptoms subside and gradual improvement begins. Convalescence is prolonged. Typhoid fever shows a wide variation in the severity and duration of illness. The over all mortality in many hospitals ranges from 5 to 10%.