Aim To examine the clinical presentations of enteric fever so as to aid their quick clinical diagnosis. Methods A systematic literature review on clinical presentations of enteric fever was carried out. Relevant information from original articles, reviewed articles, short communications, letters to the editor, and case reports over a 30 year period (1977-2007) were compiled. Data obtained was analysed using simple descriptive methods. Results Fever, headache, weakness, chills, anorexia, and fatigue were the most frequent symptoms encountered among patients with enteric fever. Also bradycardia, low blood pressure, weight loss, hepatomegaly and splenomegaly, and coated tongue were among the most frequent signs encountered among similar patients. Laboratory findings based on isolation of Salmonella spp. from specimens as well as significant titres in widal test could be used to establish diagnosis of enteric fever. Clinical presentations such as meningitis, myocarditis, splenic/hepatic abscess, psoas abscess, dysentery, haemorrhagic cystitis, pneumonia, glomerulonephritis and acute aphasia were found to be among the unexpected and unusual presentations of enteric fever. Conclusion In view of the diverse and complex presentations of typhoid fever, physicians should approach patients with infective, psychiatric and neurologic clinical features with the belief that, Salmonella infection may not be that remote a possibility. Introduction Enteric fever is caused by Salmonella typhi and Salmonella paratyphi, and globally accounts for at least 16 million infections with not less than 600,000 deaths each year1,2,3. The disease is quite of low prevalence in the developed parts of the world1. The disease is however still of a significant public health importance in Africa, parts of Asia, central and south America and other developing regions of the world2,3. In the west, the incidence of typhoid fever has been reported as low as 0.2 per 100,000 persons per year4. In the developing world on the other hand, though, accurate statistics may be lacking, the incidence of up to 13-22 per 100,000 persons per year has been documented5.Typhoid infections have been found to present with quite diverse signs and symptoms which at times has challenged the professional competence of even the well experienced medical personnel6,7. In Poland8, typhoid was found to manifest as a respiratory tract infection in a five year old boy, while in Johannesburg, South Africa9, neonatal typhoid fever believed to have been transmitted vertically was noted with invariably fatal outcome. Also in Brazil10, an unusual form of typhoid fever with cholestatic hepatitis and jaundice was encountered; patient eventually survived only after appropriate treatment for typhoid fever with ciprofloxacin was instituted. And, in Jamaica11, aphasia was unusually observed in a 20 year old adult female with typhoid fever.In view of the rare and unusual symptoms and signs of enteric fever being encountered by medical experts worldover12. And, sometimes only at post mortem examination points to the fact that several of the available textbooks on infectious diseases have not yet told us the whole story about typhoid fever13. A proper understanding of the disease with its unusual presentations would impact positively on its better and prompt management with much more encouraging outcomes14.Typhoid fever at present is still a disease of major public health importance in Nigeria and indeed the rest of Africa15,16,17. Clinical diagnosis, still useful in our hospitals, of typhoid fever could therefore pose a serious challenge among clinicians especially with complex clinical picture. This would be mo re pronounced and confusing especially when patients present late at the clinic as is often seen, when most of the classical features of the disease might have disappeared. Also, lack of adequate laboratory facilities for proper diagnosis of infectious diseases in several health centres in Africa make
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