Enteric Fevers - Clinical features
‘ Synopsis of Tropical Medicine’ P Manson-Bahr, Cassell, 1946.
Incubation period: averages 14 days ; may be 7-21. Wide range of severity ; on the whole paratyphoids milder than typhoid. Onset : in paratyphoid often sudden with rigor, headache, anorexia, bone-joint pains and insomnia. Coated tongue, dry mouth, moist facies, general apathy. Epistaxis more common in typhoid than para. Diarrhœa from commencement or alternating with constipation. Pulse: dicrotic and relatively slow. Meteorism + in typhoid; less in para. Enlarged soft spleen on second or third day; absent in many paras, sometimes in para. A. spleen is palpable during convalescence. “Rose spots” on tenth day between costal margin and umbilicus; pale-rose colour, round or lenticular. More profuse in para, especially para A. ; sometimes petechial and resemble typhus. Usually cough and bronchitis. Low muttering delirium and coma vigil ; not seen in paras. Intestinal hæmorrhage and perforation rare in para.
Typhoid-paratyphoid group characterized by pyrexia of remittent type ending by lysis, low pulse-temperature ratio, toxæmia, splenomegaly and rose spots (sometimes absent). Pulse rate is 20-40 beats per minute slower than normal pulse-temperature ratio.
Para C., common in S. America, may resemble enteric or be a septicæmia complicated by arthritis, abscesses, cholecystitis and fixation abscesses. Culture of para C. often in abscesses after quinine injections. Mild cases common.
Relapses.- Frequent in para A. ; less common in typhoid and para B.
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