For Patients & General Readers
Typhoid fever is a serious bacterial infection caused by Salmonella Typhi. It spreads through contaminated food and water, often affecting people in areas with poor sanitation. Prompt diagnosis and treatment are crucial to prevent severe complications.
Clinical Overview
Typhoid fever is a systemic febrile illness caused by Salmonella enterica serovar Typhi (S. Typhi). It is characterized by sustained fever, abdominal pain, and often a relative bradycardia, with potential for severe complications including intestinal perforation and sepsis.
Clinical Presentation
- Gradual onset of sustained fever, which may reach 39-40°C (102-104°F)
- Headache, malaise, and anorexia
- Abdominal pain, often in the right lower quadrant
- Constipation is common in the early stages, followed by diarrhea
- Relative bradycardia (pulse rate disproportionately slow relative to fever)
- Rose spots (maculopapular rash) may appear on the trunk in about one-third of cases during the second week
Signs & Symptoms
Symptoms (Patient-Reported)
- High fever
- Severe headache
- Loss of appetite
- Abdominal pain
- Constipation or diarrhea
- Weakness and fatigue
- Muscle aches
Signs (Clinician-Observed)
- Fever (sustained)
- Abdominal tenderness, particularly in the right lower quadrant
- Relative bradycardia
- Possible splenomegaly
- Rose spots (maculopapular rash)
Differential Diagnoses
| Condition | Distinguishing Feature |
|---|
| Malaria | Cyclical fever patterns, chills, and often a history of travel to endemic areas. Blood smear is diagnostic. |
| Dengue Fever | Sudden onset of high fever, severe headache (retro-orbital pain), myalgias, arthralgias, and rash. Thrombocytopenia is common. |
| Brucellosis | Undulant fever pattern, arthralgias, sweats, and a history of contact with livestock or unpasteurized dairy products. |
| Tuberculosis (intestinal) | Chronic, insidious onset of abdominal pain, weight loss, and fever. Diagnosis often requires imaging and biopsy. |
| Typhlitis (Neutropenic Enterocolitis) | Fever, abdominal pain, and tenderness in neutropenic patients, often associated with chemotherapy. Imaging is crucial. |
| Viral Gastroenteritis | More acute onset of vomiting and diarrhea, typically self-limiting. Fever may be present but usually less sustained. |
Red Flags — Seek Immediate Care
- Signs of intestinal perforation (sudden, severe abdominal pain, rigidity, rebound tenderness)
- Signs of sepsis (hypotension, tachycardia, altered mental status)
- Persistent high fever despite appropriate antibiotic therapy
- Development of complications such as meningitis or myocarditis
Key Investigations
- Blood culture (gold standard, especially in the first week of illness)
- Stool culture (positive in later stages, up to 80% by week 3)
- Bone marrow culture (highest sensitivity, especially in partially treated patients)
- Serological tests (Widal test, though less reliable for diagnosis due to variable sensitivity and specificity)
- Complete blood count (may show leukopenia with a left shift, anemia)
Management Overview
Management involves prompt initiation of appropriate antibiotics, such as azithromycin, ciprofloxacin, or ceftriaxone, based on local resistance patterns. Supportive care, including hydration and antipyretics, is essential. Public health measures, including sanitation improvement and vaccination, are crucial for prevention.
Disclaimer: This article is for educational purposes only and does not constitute medical advice.
Always consult a qualified healthcare professional for diagnosis and treatment.
TruelyserMD does not replace clinical judgement.