Typhoid fever. An epidemic with remarkably few clinical signs and symptoms

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Abstract
A major common-source, foodborne epidemic of typhoid fever occurred in San Antonio, Texas [USA], in the fall of 1981, involving 80 verified cases. The clinical course of 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 (10 patients, 30%) is summarized. 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 2 previous series originating in the USA. Hepatomegaly was noted in 7% (2 patients), splenomegaly in 13% (4 patients) and rose spots in 5% (2 patients) of the patients. Liver function test results were abnormal in 32 (95%) of the 34 patients (mean serum glutamic oxalacetic transaminase, 155 IU/ml). Typhoid fever, as seen in this outbreak, was notable for its nonspecific and mild manifestation and uniformly favorable outcome.

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