Typhoid

The classical course unfolds over weeks. In the first week fever rises in a stepladder fashion with headache, malaise, and often constipation rather than diarrhoea, and blood cultures are positive. In the second week fever plateaus, faint salmon-coloured blanching rose spots appear on the trunk, and hepatosplenomegaly and abdominal distension develop, with the characteristic relative bradycardia (Faget sign) — a pulse lower than expected for the temperature, shared with legionellosis, brucellosis, and yellow fever. In the third week, hyperplasia and necrosis of Peyer patches in the terminal ileum may cause intestinal haemorrhage or perforation, the leading causes of death. Laboratory findings include leukopenia with a left shift, anaemia, and raised transaminases. Treatment is ceftriaxone or azithromycin given rising fluoroquinolone resistance; dexamethasone is added for severe disease with shock or altered consciousness. Prevention is through sanitation, safe water, and vaccination for travellers.