Clinical Manifestations

Typhoid fever is an illness characterized by fever and headache. Other early symptoms that may occur are abdominal distension or tenderness, constipation and a few loose bowel movements, cough or bronchitis, and "rose spots" - a transient rash that usually begins on the abdomen. As the illness progresses, the headache may be more severe and be associated with mental confusion or stupor, the liver and spleen usually become enlarged, and complications such as intestinal hemorrhage, intestinal perforation, and pneumonia may occur.

If the disease is untreated, mortality ranges between 10 and 20 percent; 1 in 5 persons experiences gastrointestinal hemorrhage, and 1 in 50 suffers from perforation of the gut. Relapse occurs in about 10 percent of patients, usually after a week free of illness, but the symptoms are frequently milder and the duration shorter than during the original attack.

With early effective antibiotic treatment and supportive care, the course of the disease is markedly changed: Fever is usually gone within 3 days, and mortality is cut to less than 1 percent.

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