Atypical manifestations of typhoid fever.
BACKGROUND
High fever, toxaemia, constipation during first week of fever, complicated by encephalopathy and perforation during third week of fever are the typical manifestations of typhoid fever. However, the classical presentation of typhoid fever has considerably changed now.


OBJECTIVE
To study atypical presentations of typhoid fever.


METHODS
A teaching unit of a hospital in South India


METHODS
All culture-positive adult patients of typhoid fever admitted over a period of seven years were studied


RESULTS
Thirty-two adult patients were admitted. Fifteen (46.9%) patients presented with atypical manifestations. Atypical manifestations observed were burning micturition with normal urine examination (n= 5, 15.6%) diarrhoea in first week (6.2%), encephalopathy in first week (3.1%), isolated hepatomegaly (6.2%), pneumonitis (3.1%) and bone marrow depression (6.2%). Out of 32 Salmonella typhi culture positive patients, 10 (31.3%) patients had multidrug resistant (MDR) strain. Patients with MDR strains had atypical manifestations (5/10=50%) not significantly more often than patients having multidrug sensitive strains (10/22=45.5%) (Z <2). All patients responded to treatment.


CONCLUSIONS
It appears atypical manifestations do not necessarily mean a worse prognosis in typhoid fever. Patients having high fever presenting with pneumonia, early encephalopathy, early diarrhoea or bone marrow depression in a typhoid endemic area, should be suspected for this disease.
Dutta
T K
TK
Department of Medicine, JIPMER, Pondicherry - 605 006, India. tkduttajipmer@yahoo.co.uk
Beeresha
Ghotekar
L H
LH
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014435:Typhoid Fever / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy