Symptoms of typhoid fever

The incubation period of typhoid fever ranges from 3 to 30 days, in rare cases it lasts up to 50 days (on average 10-14 days). In the clinical course of the disease, it is possible to conditionally distinguish a period of increasing clinical symptoms (5-7 days), a period of peak (8-14 days), a decline (14-21 days) and a period of convalescence (after the 21-28th day of the disease).

The dynamics of typhoid fever symptoms depends significantly on the age of the children.

In typical cases, in older children (7-14 years old), as in adults, typhoid fever begins with a gradual increase in body temperature. From the first days of the disease, general weakness, apathy, adynamia, headache, insomnia, and anorexia are noted. Specific typhoid intoxication develops - typhoid status (stupor, drowsiness, inhibition, often hallucinations and delirium, and in severe cases - loss of consciousness). Changes in the cardiovascular system are manifested by muffled or dull heart sounds, decreased blood pressure and bradycardia. In rare cases, myocarditis may develop.

At the height of the disease (8-10th day of illness) a typical roseola rash appears on the skin. These are separate round pink spots, about 3 mm in diameter, on a pale background on the skin of the abdomen, less often on the skin of the chest and shoulders. Yellowish discoloration of the skin of the palms and feet (Filippovich's symptom) due to the development of endogenous carotenemia is considered pathognomonic for typhoid fever.

At the height of the disease, the tongue is dry, coated in the center with a thick dirty-gray (or brown) coating, the tip of the tongue and its edges remain clean, red in color, often the tongue is swollen and has teeth marks along the edges. In most patients, the abdomen is moderately distended, painful in the right iliac region, there is often a rumbling and shortening of the percussion sound as a result of hyperplasia of the mesenteric lymph nodes (Padalka's symptom). At the height of the disease, starting from the 4th-5th day of illness, the liver and spleen enlarge.

In typhoid fever, there are changes in the peripheral blood. In the first 2-3 days of the disease, the number of leukocytes may be normal or slightly increased. At the height of the disease, leukopenia and neutropenia develop with a shift in the leukocyte formula to the left to young and even to myelocytes. Aneosinophilia, lymphocytosis, increased ESR are associated with bone marrow damage. Leukopenia is expressed the more severe the disease.

In young children (up to 3-5 years), typhoid fever in most cases (up to 80%) begins acutely, with a rise in body temperature to 39-40 ° C. Symptoms of intoxication are pronounced from the first hours of the disease. Children become irritable, lethargic, pale, refuse to breastfeed, scream, cry. Anxiety, drowsiness, adynamia, sleep inversion (drowsiness during the day and insomnia at night) are noted. In severe cases, repeated vomiting, convulsions, and impaired consciousness occur from the first days. Dryness of the mucous membranes of the mouth and lips is observed, and in most cases, diarrhea syndrome (enteritis) occurs from the first days of the disease. The stool becomes liquid, profuse, undigested, with an admixture of transparent mucus and greenery, with a frequency of up to 10-15 times a day or more. Constipation and intestinal paresis are less common. As a result of severe gastrointestinal disorders (vomiting and loose stools), dehydration of the body with toxicosis and exsicosis easily develops, which worsens the patient's condition.

In young children (especially in the first year of life), tachycardia, a drop in blood pressure, and muffled heart sounds are observed. Unlike older children, hepatosplenomegaly is more pronounced. Roseola rash is rare and more sparse. Most patients have neutropenia with a nuclear shift in leukocytes, hypoeosinophilia, and an increase in ESR. Leukopenia is rare, and leukocytosis is more common.