Which combination of signs is classic for enteric fever caused by Salmonella Typhi?

• A. Prolonged fever with stepwise pattern, abdominal pain, hepatosplenomegaly, relative bradycardia, and sometimes rose-colored spots on trunk
• B. Sudden high fever with severe diarrhea only
• C. Rash and cough without fever
• D. Abdominal pain with vomiting but no fever

Answer: (D)

Recognize the classic presentation of typhoid fever caused by Salmonella Typhi. The defining pattern is a prolonged fever that often rises in a stepwise fashion, accompanied by abdominal pain and enlargement of the liver and spleen. A relatively slow pulse compared with the fever (relative bradycardia) and sometimes rose-colored spots on the trunk are classic accompanying signs. This combination of sustained, evolving fever with abdominal involvement and specific signs points most strongly to enteric fever rather than other febrile illnesses. Patterns like sudden high fever with diarrhea, or fever absent with vomiting or just a rash or cough, don’t fit enteric fever as well because they lack the characteristic fever trajectory and the abdominal findings that define typhoid.