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March 1984

Typhoid Fever: An Epidemic With Remarkably Few Clinical Signs and Symptoms

Author Affiliations

From the Infectious Diseases Section, Audie L. Murphy Memorial Veterans Administration Hospital (Drs Klotz and Craven); and the Departments of Medicine (Drs Klotz and Craven) and Pathology (Dr Jorgensen), University of Texas Health Science Center, San Antonio, Tex. Dr Buckwold has a clinical faculty position at the University of Texas Health Science Center and is in private practice in San Antonio.

Arch Intern Med. 1984;144(3):533-537. doi:10.1001/archinte.1984.00350150127032

• A major common-source, foodborne epidemic of typhoid fever occurred in San Antonio, Tex, in the fall of 1981, involving 80 verified cases. We summarize the clinical course of our 34 patients who had a nonspecific symptom complex that included at the initial examination fever (32 patients, 93%), headache (19 patients, 57%), diarrhea (11 patients, 33%), and anorexia (ten patients, 30%). The most common initial diagnoses were urinary tract and upper respiratory tract infections. The subsequent isolation of Salmonella typhi from blood cultures was usually unexpected. Physical findings were different from two previous series originating in the United States. Hepatomegaly was noted in only 7% (two patients), splenomegaly was noted in 13% (four patients), and rose spots were noted in 5% (two patients) of the patients. Liver function test results, however, were abnormal in 32 (95%) of the 34 patients (mean SGOT, 155 IU/mL). Typhoid fever, as seen in this outbreak, was notable for its nonspecific and mild manifestation and uniformly favorable outcome.

(Arch Intern Med 1984;144:533-537)