Following are the features of enteric fever in the first week
- Step-ladder pattern of pyrexia.
- Frontal headache.
- Constipation.
- Anorexia, nausea, cough and epistaxis.
- Flushed face with toxic look.
- Angry looking tongue, central coating with red tip and margins
- Caecal gurgling.
- Relative bradycardia and rarely dicrotic pulse
- Appearance of rash on the 7th day (usually appears on 7th-10th day).
- The spleen may be just palpable, soft and tender spleen at the end of first week is seen
What is typhoid state ?
If the enteric fever is untreated it may enter into a toxemic phase towards the end of 3 week and is manifested as the following
- Semiconsciousness or unconsciousness.
- Low muttering delirium.
- Coma vigil - Patient lies with half-open eyes but ignorant of his surroundings
- Carphology manifested as picking of bed clothes
- Sub sultus tendinus this is the involuntary movement of the fingers and wrist
- Convulsions rarely.
