Insidious onset with malaise, headache, myalgia,

dry cough, anorexia and fever

Abdominal pain, distension and tenderness

Sustained high fever

Diarrhoea early and late, constipation in mid course of illness

Ileal perforation (due to necrosis of Peyer patch in bowel wall) resulting in peritonitis in ∼2%

Gastrointestinal bleeding (due to erosion of Peyer patch into vessel) in ∼15%

Encephalopathy in ∼10%

Liver and spleen often palpable after first week

Erythematous macular rash (rose spots) on upper

abdomen and anterior chest (may occur during second week) in ∼25%

Raised white cell count

Mild thrombocytopenia

Abnormal liver function tests

Blood culture positive in 40–80%

Stool and urine culture positive after first week

Laboratory should test isolates for fluoroquinolone resistance (common)

Supportive management as for severe sepsis

Antibiotic therapy with azithromycin or ceftriaxone