Typhoid fever progresses through four stages over 4 weeks. In the first week, symptoms include rising fever and headaches. The second week brings high spiking fevers, delirium, and a characteristic rash. Complications can occur in the third week such as intestinal bleeding or perforation. Transmission is usually through contaminated food or water. Diagnosis involves blood or stool cultures while treatment consists of antibiotics and rehydration.

1. TYPHOID

2.  The course of un-treated typhoid fever is divided
into 4 individual stages.
 Each stage lasting approximately 1 week, in the
first week there is a slowly rising temperature with
relative brady cardia, malaise, headache ,cough
and bleeding nose (epistaxis) abdominal pain is
also possible.

3.  There is leucopenia a decrease in the no. of
circulating WBC with eosinophenia and relative
lymphocytosis.
 A positive reaction and blood cultures are positive
for salmonella typhi or paratyphi.
 The clasic widal test is negative in the first week
 In the second week of the infection, the patient
have high fever(40°c) and brady cardia classically
with a dicrotic pulse wave.

4.  Delirium is frequently calm but sometimes agitated. This
delirium gives to typhoid the nick name of “ nervous
fever”
 Rose spots appears on the lower chest and abdomen.
 Bronchitis in lung
 Diarrhea can occur in this stage 6 to 8 stools in a day,
green with a characteristic smell, comparable to pea
soup
 Constipation is also frequent

5.  The spleen and liver are enlarged (hepato- spleeno
megaly) and tender
 There is elevation of liver transaminase
 The major symptom of this fever is that the fever
usually rises in the after noon up to the 1st and 2nd
weeks.

6.  In the 3rd week no. of complications can occurs
1. intestinal hemorrhage due to bleeding in
congested payer’s patches.
2. Intestinal perforations in the distal ileum
3. Encephalitis
4. Neuro psychiatric symptoms
5. Metastatic abcesses, cholecystitis, endocardytis

7.  The fever is still very high and oscillates very little
over 24 hrs
 By the end of 3rd week the fever has started
reducing this carries into the 4th and final week.

8. TRANSMISSION
 It may spread through poor hygiene habits and
public sanitation conditions and sometimes also by
flying insevts feeding on feces.
 A person may become an asymptomatic carrier of
typhoid fever, suffering no symptoms, but capable
of infecting others

9. DIAGNOSIS
 Blood, bone marrow or stool cultures and with widal
test (demonstration of salmonella antibodies
against antigen O- somatic and H- flagellar)
 Therapeutic trial with chloramphenicol
 Stool culture

10. PREVENTION
 Typhoid vaccine : oral Ty- 21- a vaccine and
infectable typhoid polysaccharide vaccine
 Both are between 50% to 80% protective and are
recommended for travelers to areas where typhoid
is endemic.

11. MEDICAL TREATMENT
 Oral rehydration therapy
 Antibiotics such as ampicillin, chloramphenecol,
trimetho prim- sulfa methoxazole, amoxicillin,
ciprofloxacin.

12. SURGICAL TREATMENT
 In cases of intestinal perforation whole cystectomy