Symptoms of typhoid fever

The incubation period of typhoid fever ranges from 3 to 30 days, in rare cases lasts up to 50 days (an average of 10-14 days). In the clinical course of the disease, the period of the increase in clinical symptoms (5-7 days), the period of heat (8-14 days), extinction (14-21 days) and the period of convalescence (after the 21-28th day of the disease) can be conventionally identified.

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

In typical cases in older children (7-14 years), as in adults, typhoid fever begins with a gradual increase in body temperature. From the first days of the illness, general weakness, apathy, adynamia, headache, insomnia, anorexia are noted. Specific typhoid intoxication - typhoid status develops (deafness, drowsiness, blocking, often hallucinations and delirium, and in severe cases - loss of consciousness). Changes in the cardiovascular system are manifested by muffling or deafness of cardiac tones, lowering of arterial pressure and bradycardia. In rare cases, the phenomenon of myocarditis can develop.

At the height of the disease (the 8th-10th day of the disease), a typical rosaolous rash appears on the skin. These are separate round spots of pink color, with a diameter of about 3 mm, on a pale background on the skin of the abdomen, less often on the skin of the chest and shoulders. Pathognomonic for typhoid is considered icteric staining of the skin of the palms and feet (symptom Filippovicha) due to the development of endogenous caroteneemia.

At the height of the disease the tongue is dry, in the center it is covered with a dense gray-gray (or brown) coating, the tip of the tongue and its edges remain clean, red, often the tongue is edentulous and has teeth marks at the edges. In most patients, the abdomen is moderately inflated, painful in the right ileal region, rumbling and shortening of percussion sound as a result of hyperplasia of the lymph nodes of the mesentery (Padalka symptom) is often found there. At the height of the disease, starting from the 4th-5th day of the disease, the liver and spleen increase.

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

In young children (up to 3-5 years), typhoid fever in most cases (up to 80%) begins acutely, with the rise in body temperature to 39-40 ° C. Since the first hours of the disease, the symptoms of intoxication are clearly pronounced. Children become irritable, flaccid, pale, give up their breasts, cry out, cry. They note anxiety, drowsiness, adynamy, sleep inversion (drowsiness during the day and sleeplessness at night). In severe cases, from the first days there are repeated vomiting, convulsions, a violation of consciousness. Observe the dryness of the mucous membranes of the mouth, lips, in most cases from the first days of the disease diarrhea syndrome (enteritis). The stool becomes liquid, plentiful, undigested, with an admixture of transparent mucus and greens, with a frequency of up to 10-15 times a day or more. Less common are constipation and paresis of the intestine. Due to severe gastrointestinal disorders (vomiting and loose stools), dehydration of the body with toxicosis with exsicosis is easy, which makes the patient worse.

In young children (especially the first year of life), tachycardia, a drop in blood pressure, and muffling of heart sounds are observed. Unlike older children, hepatosplenomegaly is more pronounced in them. Rose-rash is rarely and more scarce. In most patients, neutropenia with a nuclear shift of leukocytes, hypoeosinophilia and an increase in ESR are noted. Leukopenia is rarely seen, and leukocytosis often occurs.