Even typhoid can present with chills and rigors

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Changing trends have been reported in typhoid fever since last decade. Continuous and intermittent fever with rigors and chills, headache, bodyaches, abdominal pain, enlarged spleen, enlarged liver, high pulse rate, and deranged liver functions are more commonly observed in typhoid fever, reports Dr NS Neki, Assistant Professor Dept. of Medicine Govt. Medical College Amritsar, Punjab in January issue of Indian Journal of Clinical Practice.

In the study of 100 patients 48, 30, 14 and 8 were in the age group of 20-30, 31-40, 41-50 and 51-60 years, respectively. In all the patients, fever (100-104°F) was the major presenting symptom. Duration of fever was one week in 32%, 1-2 weeks in 40%, 2-3 weeks in 20%, 3-4 weeks in 7% and >4 weeks in 1% patients. 65 patients presented with continuous fever and 32% with intermittent fever and 3% with remittent fever.

Sixty percent patients presented with rigors and chills and 40% without rigors and chills. Headache was reported in 80%, body ache in 60%, abdominal pain in 13%, cough in 10%, nausea in 4%, constipation in 2% and vomiting is 2% cases.

Clinical findings were enlarged spleen in 70%; high pulse rate in 65%; enlarged liver in 23%, coated tongue 12%; relative slow pulse rate in 3% and irritation of the brain layers in 3% with stupor in 1%.

Laboratory findings were anemia with Hb 6-11 g/dl in 25%; severe anemia with Hb <6 g/dl in 16%; neutropenia or low white cells in 9%; lymphopenia in 4%; lymphocytosis in 2%; low platelet count in 4 %; raised liver enzymes SGOT and SGPT in 42%; raised alkaline phosphatase in 7% and raised serum bilirubin in 5% cases.

Presence of fever with child and rigors does not always mean malaria or urinary tract infection.

If the fever is continuous, then one should look for typhoid. Raised SGOT and SGPT levels can be present in most viral fevers especially in the dengue season, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, Editor in Chief IJCP.