What are the symptoms of typhoid fever?

Symptoms of Typhoid Fever

Typhoid fever classically presents with sustained high-grade fever (present in 97-100% of cases), headache, malaise, anorexia, and gastrointestinal symptoms including abdominal pain with either constipation or diarrhea. 1, 2

Core Clinical Features

Constitutional Symptoms

• Fever is the hallmark symptom, occurring in virtually all cases (97-100%), typically sustained and high-grade with insidious onset developing over 3-7 days rather than abruptly 1, 2
• Headache is a prominent and common presenting symptom 1, 2, 3
• Malaise and myalgia are typical constitutional features 2
• Anorexia (loss of appetite) is consistently reported 1, 2

Gastrointestinal Manifestations

• Abdominal pain is a frequent complaint 1, 2, 3
• Constipation or diarrhea can both occur—the disease does not consistently present with one or the other 1, 2
• Nausea and vomiting are common symptoms 1, 2

Respiratory Symptoms

• Nonproductive cough may be present despite this being primarily a systemic infection 1, 2

Physical Examination Findings

• Relative bradycardia (pulse-temperature dissociation) can occur, where the heart rate is paradoxically slow despite high fever 2, 3
• Rose-colored rash is a classic but inconsistently present finding 3

Timeline and Presentation Pattern

• The incubation period is 7-18 days (range 3-60 days) after exposure 2
• Symptoms typically develop insidiously over several days rather than suddenly 2
• Average duration of symptoms before patients seek care is approximately 8 days 3
• The classic "step-ladder" fever pattern is not reliably present in all cases 2

Important Clinical Pearls

Fever may not be present at the initial presentation if the patient has taken antipyretics, but a history of fever should be elicited 2. The absence of fever at one point in time does not exclude typhoid fever.

Leukopenia (low white blood cell count) is common and can be a helpful diagnostic clue, along with lymphopenia and thrombocytopenia 4, 3.

Severe Complications to Recognize

• Intestinal perforation typically occurs in the third week if untreated, most commonly in the ileum or jejunum 2
• Gastrointestinal bleeding can develop 2
• Encephalopathy (altered mental status/coma) is a rare but serious complication 2, 5
• Septic shock can occur in severe cases 2, 5

Epidemiological Context

Typhoid fever should be strongly considered in patients with fever and the above symptoms who have recently traveled to endemic areas, particularly South and Southeast Asia, or who are from these regions 2, 3. In developed countries, it is primarily seen in returning travelers or associated with foodborne outbreaks 2.