Typhoid fever is characterize by a continued fever as high as 40°C (104°F), profuse sweating, gastroenteritis, and nonbloody diarrhea. Less generally a rash of flat, rose-colored spots may appear.[3]
Naturally, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a gradually rising temperature with relative bradycardia, malaise, headache and cough. Epistaxis is seen in a sector of cases and abdominal pain is also possible. There may be a leukopenia with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella Typhi or Paratyphi. The typical Widal test is negative in the first week.
In the second week of the illness, the patient lies prostrated with high fever in plateau around 104°F (40°C) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is common, frequently calm, but sometimes agitated. This delirium gives to typhoid the pet name of "nervous fever". Rose spots show on the lower chest and abdomen in around 1/3 patients. There are rhonchi in lung basis. The abdomen is swollen and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a typical smell, comparable to pea-soup. But, constipation is also frequent. The spleen and liver are distended (hepatosplenomegaly) and tender and there is elevation of liver transaminases. The Widal reaction is powerfully positive with antiO and antiH antibodies. Blood cultures are at times still positive at this stage.
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