Over the course of the first week of illness, the notorious gastrointestinal manifestations of typhoid fever develop. These include diffuse abdominal pain and tenderness and, in some cases, fierce, colicky right upper-quadrant pain. Monocytic infiltration with Peyer patches is indicative of the inflammation within the bowel and may narrow the bowel lumen, causing constipation that lasts for the duration of the illness. The individual then develops a dry cough, dull frontal headache, delirium, and an increasingly stuporous malaise, which lasts into the second week. Acute high fever is very rare in the first week.
Some patients, especially in India and Africa, present primarily with neurologic manifestations, such as delirium or, in extremely rare cases, parkinsonian symptoms or Guillain-Barré syndrome. Other unusual complications include pancreatitis, meningitis, orchitis, osteomyelitis, and metastatic abscesses.
For more on the presentation of typhoid fever, read here.
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Cite this: Richard H. Sinert, Mary L. Windle, Michael Stuart Bronze, et. al. Fast Five Quiz: Can You Answer These Challenging Emergency Medicine Questions? - Medscape - Mar 09, 2017.