03/10/2019
🔖Signs and symptoms of Typhoid fever:-
🖇At the first week
-Rose spots on chest of a person with typhoid fever.
-the body temperature rises slowly, and fever fluctuations are seen.
-bradycardia (Faget sign).
- malaise.
-headache.
-cough.
- A bloody nose (epistaxis) is seen in a quarter of cases.
- abdominal pain is also possible.
-A decrease in the number of circulating white blood cells (leukopenia) occurs with eosinopenia and relative lymphocytosis.
🖇In the second week:
-the person is often too tired to get up.
- high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation or Faget sign), classically with a dicrotic pulse wave. Delirium can occur, where the patient is often calm, but sometimes becomes agitated. This delirium has led to typhoid receiving the nickname "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. Rhonchi (rattling breathing sounds) are heard in the base of the lungs. The abdomen is distended and painful in the right lower quadrant, where a rumbling sound can be heard. Diarrhea can occur in this stage, but constipation is also common. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and liver transaminases are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. The major symptom of this fever is that it usually rises in the afternoon up to the first and second week.
In the third week of typhoid fever, a number of complications can occur:
Intestinal haemorrhage due to bleeding in congested Peyer's patches occurs; this can be very serious, but is usually not fatal.
Intestinal perforation in the distal ileum is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
Encephalitis
Respiratory diseases such as pneumonia and acute bronchitis
Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects
Metastatic abscesses, cholecystitis, endocarditis, and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues, and the patient is delirious (typhoid state). One-third of affected individuals develop a macular rash on the trunk.
Platelet count goes down slowly and the risk of bleeding rises.
By the end of third week, the fever starts subsiding.
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