Spontaneous splenic rupture and multiple brain abscesses also have been reported. No reported racial predilection exists. US travelers abroad have about a 1 in 10,000 risk of contracting typhoid fever, but this risk increases several fold when visiting countries with endemic typhoid. Symptoms develop gradually in most cases with maximal severity occurring during the second or third week following exposure. Constitutional symptoms include fever, chills, headache, sore throat, muscle pain, and weakness.
Many patients complain of a skin rash and cervical adenopathy.
Gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, constipation, and abdominal pain. Neurologic symptoms include altered mental status and occasional seizures. Patients with ocular manifestations generally complain of pain and decreased vision. Recovery is characterized by diminishing fever and begins by the fourth week in patients without antibiotic treatment. In contrast, antibiotic use usually results in defervescence in less than 7 days.