clinical features

Last edited 02/2020

Typhoid fever:

• insidious onset of a systemic illness: symptoms may include sustained fever, marked headache, malaise, anorexia, abdominal pain, diarrhoea.
• there is a wide variation in clinical severity.
• complications may include intestinal haemorrhage or perforation (about 1-4% of cases), renal failure or osteomyelitis. Other rare complications include cholecystitis, meningitis and pneumonia.
• case-fatality rate of 10–20% observed in the pre-antibiotic era can fall below 1% with prompt antibiotic therapy.
• 5–20% of patients may experience relapses

In the UK, faecal carriage and relapse rates are estimated at <3%.

Paratyphoid fever:

• Clinically similar but usually less severe than typhoid
• Complications are less common.
• Relapses may occur in up to 9% of cases
• S.Paratyphi C infections are rare

Enteric fever can be successfully treated with antibiotic therapy and general medical support. Treatment should be subject to clinical opinion and antibiotic sensitivity.

Detailed description of severe episode:

• after an incubation period of 7 to 21 days, the illness begins insidiously with non-specific symptoms. In the first week there may be headache, malaise and a rising intermittent pyrexia, in the presence of a relative bradycardia. There may also be a cough, and constipation occurs more commonly than diarrhoea
  
  
• in the second week the patient may become dull and apathetic and complain of diarrhoea. The high pyrexia becomes sustained, and again there may be a relative bradycardia. The abdomen is often distended, slightly tender and 75% of patients have splenomegaly. Crops of red macules called rose spots may also appear

• in the third week, the patient my become toxic and delirious with a continuing high fever. The abdomen remains markedly distended and "pea soup" diarrhoea is common. At this stage life-threatening intestinal haemorrhage or perforation are likely to occur. Toxaemic myocarditis may also occur
  
  
• patients who survive the third week slowly improve over ten days, with the fever, mental state and abdominal distention improving. Intestinal haemorrhage and perforation however may still occur. By this stage the patient has often lost a lot of weight and remains profoundly weak for a short period
  
  
• ten percent of patients relapse 1 to 3 weeks after apparent recovery, or 2 weeks or so after stopping treatment. Relapse is similar to the initial illness with positive blood cultures, though its course is often milder.
  
  
• Infected patients may become carriers

Reference:

• PHE (2019). Recommendations for the Public Health Management of Gastrointestinal Infections