Typhoid fever physical examination

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	Severe distress Delirious or unconscious^[5]
Vital signs	Step-wise increase in temperature Bradycardia^[1]	High grade fever which plateaus around 40°C	Rising pulse Falling blood pressure (shock) Decreased or increased temperature^[5]
Skin	Normal to mild pallor	Pallor++ Blanching erythematous maculopapular lesions on the lower chest and abdomen (1/3 patients)	Pallor+++ (intestinal bleeding)^[6] Bruises (DIC)
HEENT	Mild dehydration	Lymphadenopathy Conjuctival pallor	Sunken eyes Dry skin Coated dry tongue
CV	Bradycardia	Bradycardia	Irregular rate Rhythm and murmers (myocarditis)^[7]
Pulmonary	Normal	Ronchi (few)	Crepitations (pneumonia)
Abdomen	Normal to mild tenderness	Abdominal tenderness++ Abdominal distension+	Tenderness+++ (right lower quadrant) Hepatosplenomegaly Absent bowel sounds (peritonitis)^[4]^[5]
Neurological	Alert and oriented	Altered level of consciousness	Delirium or agitation Neck stiffness (meningitis) Rigidity^[8]
Musculoskeletal	Normal	Mild muscle or joint tenderness	Joint swelling and tenderness

References

↑ ^1.0 ^1.1 Ostergaard L, Huniche B, Andersen PL (1996). “Relative bradycardia in infectious diseases”. J Infect. 33 (3): 185–91. PMID 8945708.
↑ ^2.0 ^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.
↑ ^3.0 ^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.
↑ ^4.0 ^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.
↑ ^5.0 ^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.
↑ 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.
↑ 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.
↑ 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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[pmid8945708-1] 1.0 ^1.1 Ostergaard L, Huniche B, Andersen PL (1996). “Relative bradycardia in infectious diseases”. J Infect. 33 (3): 185–91. PMID 8945708.

[pmid12456854-2] 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.

[pmid26649174-3] 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.

[pmid22357703-4] 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.

[pmid6361558-5] 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.

[pmid26901611-6] 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.

[pmid26730299-7] 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.

[pmid22357702-8] 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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Typhoid fever physical examination

Overview

Physical examination

References

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