Diagnosis Protocol

Insidious onset of sustained fever (39–40°C). Headache, malaise. Relative bradycardia (pulse lower than expected for fever). Rose spots (faint rash on trunk). Constipation or diarrhoea. Splenomegaly, hepatomegaly. Week 3+: Complications — intestinal perforation, haemorrhage, toxic encephalopathy.

Blood culture (most sensitive in first 2 weeks — gold standard). Widal test (>1:160 titre suggestive, interpret with care in endemic area). Stool and urine culture (weeks 2–3). FBC: relative leucopenia.