Editing Typhoid fever (section)

== Signs and symptoms ==
Classically, the progression of untreated typhoid fever has three distinct stages, each lasting about a week. Over the course of these stages, the patient becomes exhausted and emaciated.<ref>{{cite web|title=Typhoid|url=http://www.merriam-webster.com/dictionary/typhoid|publisher=Merriam Webster Dictionary|access-date=2013-06-24|url-status=live|archive-url=https://web.archive.org/web/20130702140640/http://www.merriam-webster.com/dictionary/typhoid|archive-date=2013-07-02}}</ref>{{better source|reason=need something better than a dictionary|date=May 2025}}
* In the first week, the body temperature rises slowly, and fever fluctuations are seen with relative [[bradycardia]] ([[Faget sign]]), [[malaise]], headache, and cough. A bloody nose ([[epistaxis]]) is seen in a quarter of cases, and abdominal pain is also possible. A decrease in the number of circulating white blood cells ([[leukopenia]]) occurs with [[eosinopenia]] and relative [[lymphocytosis]]; blood cultures are positive for ''S. enterica'' subsp. enterica serovar Typhi. The [[Widal test]] is usually negative.<ref name="pmid27796818">{{cite journal | vauthors = Kumar P, Kumar R | s2cid = 3825885 | title = Enteric Fever | journal = Indian Journal of Pediatrics | volume = 84 | issue = 3 | pages = 227–230 | date = March 2017 | pmid = 27796818 | doi = 10.1007/s12098-016-2246-4 }}</ref>
* In the second week, the person is often too tired to get up, with high fever in plateau around {{convert|40|°C|°F|abbr=on}} and bradycardia (sphygmothermic dissociation or Faget sign), classically with a [[dicrotic pulse]] wave. [[Delirium]] can occur, where the patient is often calm, but sometimes becomes agitated. This delirium has given typhoid the nickname "nervous fever". [[Rose spots]] appear on the lower chest and abdomen in around a third of patients. [[Rhonchi]] (rattling breathing sounds) are heard in the base of the lungs. The abdomen is distended and painful in the right lower quadrant, where a rumbling sound can be heard. Diarrhea can occur in this stage, but constipation is also common. The spleen and liver are enlarged ([[hepatosplenomegaly]]) and tender, and liver [[transaminases]] are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive.{{cn|date=March 2023}}
* In the third week of typhoid fever, possible complications include:
** The fever is still very high and oscillates very little over 24 hours. [[Dehydration]] ensues along with malnutrition, and the patient is delirious. A third of affected people develop a macular rash on the trunk.
** [[Gastrointestinal bleeding|Intestinal haemorrhage]] due to bleeding in congested [[Peyer's patches]] occurs; this can be very serious but is usually not fatal.
** Intestinal perforation in the distal [[ileum]] is a critical complication and often fatal. It may occur without alarming symptoms until [[sepsis]] or diffuse [[peritonitis]] sets in.
** Respiratory diseases such as [[pneumonia]] and [[acute bronchitis]]
** [[Encephalitis]]
** Neuropsychiatric symptoms (described as "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects.
** Metastatic abscesses, [[cholecystitis]], [[endocarditis]], and [[osteitis]].
** Low platelet count ([[thrombocytopenia]]) is sometimes seen.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/001332.htm|title=Typhoid fever: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2020-04-21}}</ref>