Typhoid fever exhibits in various forms. Typically, it starts with malaise, anorexia, muscular aches and fevers,that increases everyday by 0.25-0.50C to reach to 39 to 410 C coupled with abdominal pain & headaches. Fever rises to 410 C in 5-7 days where it stays for 10-15 days if untreated, then fever decreases slowly over several days.
During the period of rise in fever, some patients (20%) with fair skin show “rose spots” of 2-4 mm in the chest, abdomen & back areas. Constipation is typically observed.
In blood – leukocytes are below 4500/mm3 & platelets less 80,000/mm3 . Liver dysfunction may be present and can be detected by elevated serum transaminase values.
Two of most important complications are perforations & hemorrhage as a result of intestinal lesions (See figure).
Other uncommon complications are hepatitis, empyema, osteomyelitis & psychosis. Particularly severe form of typhoid can cause cerebral dysfunction, delirium or coma and shock, case fatality in such cases can exceed 20%.
About 2% to 5% patients become chronic gallbladder carriers of the organism where it has been implicated as a cause of cancer.