Enteric Fever (Typhoid & Paratyphoid)
Enteric fever is a systemic infectious disease characterized by prolonged fever, abdominal pain, and involvement of the reticuloendothelial system, caused by Salmonella Typhi or Salmonella Paratyphi.
1. Clinical Progression (The Classic Weeks)
| Phase | Clinical Features |
|---|---|
| Week 1 | Step-ladder fever, relative bradycardia (Faget sign), and abdominal discomfort. |
| Week 2 | “Rose spots” on the trunk, hepatosplenomegaly, and delirium (“typhoid state”). |
| Week 3 | Complications risk peak: Intestinal hemorrhage and ileal perforation. |
2. High-Yield Diagnostics & Management
- Gold Standard: Bone marrow culture (highest sensitivity), followed by blood culture (best in the 1st week).
- Widal Test: Detects O and H antibodies. A fourfold rise in titers is diagnostic; false positives are common.
- Management: Ceftriaxone or Azithromycin are currently preferred due to rising fluoroquinolone resistance.
3. Critical Complications
- Ileal Perforation: Occurs due to necrosis of Peyer’s patches. Requires surgical intervention and aggressive fluid management.
- Carrier State: Chronic carriage (in the gallbladder) is common, especially in patients with gallstones.
NEET PG Hint: Remember: Relative bradycardia (dissociation between heart rate and temperature) is a classic finding in Enteric fever. Also, remember that Peyer’s patches in the terminal ileum are the primary site of infection. For more high-yield infectious disease protocols and free medical questions, visit mymedschool.org.