What are atypical presentations of typhoid fever (enteric fever)?

Updated: Aug 19, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Atypical manifestations of typhoid fever include isolated severe headaches that may mimic meningitis, acute lobar pneumonia, isolated arthralgias, urinary symptoms, severe jaundice, or fever alone. Some patients, especially in India and Africa, present primarily with neurologic manifestations such as delirium or, in extremely rare cases, parkinsonian symptoms or Guillain-Barré syndrome. Other unusual complications include pancreatitis, [31] meningitis, orchitis, osteomyelitis, and abscesses anywhere on the body. [2]

Table 1. Incidence and Timing of Various Manifestations of Untreated Typhoid Fever [2, 32, 33, 34, 35, 36] (Open Table in a new window)

 

Incubation

Week 1

Week 2

Week 3

Week 4

Post

Systemic

Recovery phase or death (15% of untreated cases)

10%-20% relapse; 3%-4% chronic carriers;

long-term neurologic sequelae (extremely rare);

gallbladder cancer (RR=167; carriers)

Stepladder fever pattern or insidious onset fever

 

Very commona

Very common

Acute high fever

 

Very rareb

 

 

Chills

 

Almost allc

Rigors

 

Uncommon

Anorexia

 

Almost all

Diaphoresis

 

Very common

Neurologic

Malaise

 

Almost all

Almost all

Typhoid state (common)

Insomnia

 

 

Very common

Confusion/delirium

 

Commond

Very common

Psychosis

 

Very rare

Common

 

Catatonia

 

Very rare

 

 

Frontal headache

(usually mild)

 

Very common

 

 

Meningeal signs

 

Raree

Rare

 

Parkinsonism

 

Very rare

 

 

Ear, nose, and throat

Coated tongue

 

Very common

 

 

Sore throatf

 

 

 

 

Pulmonary

Mild cough

 

Common

 

 

Bronchitic cough

 

Common

 

 

Rales

 

Common

 

 

Pneumonia

 

Rare (lobar)

Rare

Common

(basal)

Cardiovascular

Dicrotic pulse

 

Rare

Common

Myocarditis

 

Rare

 

 

Pericarditis

 

Extremely rareg

 

 

Thrombophlebitis

 

 

 

Very rare

Gastrointestinal

Constipation

 

Very common

Common

Diarrhea

 

Rare

Common (pea soup)

Bloating with tympany

 

Very common (84%) [36]

 

 

Diffuse mild abdominal pain

 

Very common

 

 

Sharp right lower quadrant pain

 

Rare

 

 

Gastrointestinal hemorrhage

 

Very rare; usually trace

Very common

intestinal perforation

 

 

 

Rare

Hepatosplenomegaly

 

Common

Jaundice

 

Common

Gallbladder pain

 

Very rare

Urogenital

Urinary retention

 

Common

Hematuria

 

Rare

Renal pain

 

Rare

Musculoskeletal

Myalgias

Very rare

Arthralgias

Very rare

Rheumatologic

Arthritis (large joint)

Extremely rare

Dermatologic

Rose spots

 

Rare

Miscellaneous

Abscess (anywhere)

 

Extremely rare

Extremely rare

Extremely rare

a Very common: Symptoms occur in well over half of cases (approximately 65%-95%).

b Very rare: Symptoms occur in less than 5% of cases.

c Almost all: Symptoms occur in almost all cases.

d Common: Symptoms occur in 35%-65% of cases.

e Rare: Symptoms occur in 5%-35% of cases.

f Blank cells: No mention of the symptom at that phase was found in the literature.

g Extremely rare: Symptoms have been described in occasional case reports.


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