Typhoid or paratyphoid should be suspected in all febrile and seriously ill patients returning from endemic areas where malaria has been excluded. Typhoid is common in almost all of Asia, Africa, and Southern America. Clinical history and examination are non-specific. A history of fever with headache is typical, and cough, meningism, constipation, and diarrhea are all common. Splenic and hepatic enlargement are common, and a tender distended abdomen occurs in most severe cases. Nuchal rigidity and localized chest signs may be misleading. A relative bradycardia is classical but seldom helpful. Crops of pink blanching papules (rose spots) on the trunk occur in up to 50 per cent of cases, but are difficult to detect in dark skin.

Confirmation of typhoid requires isolation of the organism. Blood cultures are usually positive in the early stages of the disease, but fall to less than 50 per cent in cases presenting late in the course of infection. The classical progression of typhoid is of mild to moderate disease in the first week, progressing to severe disease in the second to third weeks. Therefore confirmation of typhoid in critically ill patients may not be possible with blood cultures. Bone marrow culture has a yield of up to 90 per cent, even where patients have had antibiotics, and should be used where the diagnosis is considered in seriously ill patients. Fecal cultures become positive in many cases as the disease progresses. Urine cultures may yield the organism.

The Widal test is seldom helpful in the acute setting. A rise in titers over time is too late to be of practical help in management. New methods of serodiagnosis are under development. The full blood count can show a normal, raised, or low white cell count. Leukopenia is common as the illness progresses.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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