Incidence of Calf Pain in Typhoid Fever
Calf pain is not a recognized clinical feature of typhoid fever and does not appear in the documented symptomatology of this disease.
Clinical Features of Typhoid Fever
The established clinical presentation of typhoid fever does not include calf pain as a symptom. The documented features are:
Common Presenting Symptoms
- Fever is present in 97-100% of cases, typically sustained and high-grade with insidious onset over 3-7 days 1
- Headache, malaise, and anorexia are common constitutional symptoms 1
- Gastrointestinal symptoms including abdominal pain, constipation or diarrhea, nausea, and vomiting 1
- Nonproductive cough may be present 1
Less Common Features
- Relative bradycardia (Faget sign) can occur 2
- Hepatomegaly and splenomegaly may develop 3
- Sensorineural hearing loss has been reported as an atypical presentation 4
Important Clinical Distinction
Calf pain and tenderness are specifically documented as features of Rocky Mountain Spotted Fever (RMSF), not typhoid fever 5. The guidelines explicitly state that calf pain is among the "less commonly observed" findings in RMSF, along with bilateral periorbital edema and edema of the dorsum of hands and feet 5.
Key Pitfall to Avoid
Do not confuse the clinical presentations of tickborne rickettsial diseases (which include calf pain) with typhoid fever (which does not). Both can present with fever and nonspecific symptoms, but their distinguishing features differ significantly 5, 1.
Clinical Implications
When evaluating a patient with fever and calf pain:
- Consider RMSF or other tickborne rickettsial diseases rather than typhoid fever 5
- For typhoid fever diagnosis, focus on the classic triad of sustained fever, gastrointestinal symptoms, and travel history to endemic areas (South/Southeast Asia) 1, 6
- Obtain blood cultures (2-3 specimens of 20 mL each in adults) before initiating antibiotics, as this is the gold standard for typhoid diagnosis 6