Joint Symptoms in Typhoid Fever

To the Editor, The Indian Medicai, Gazette. Sir,?In the Epitome of Current Medical Literature in the British Medical Journal of the 18th June, 1927, H. Schaeffer and R. Liegears are said to state that though joint symptoms are not common in typhoid fever they are not extremely rare. They describe three forms: " The first constitutes the arthralgic form of Bazin and Potain which is characterised merely by transient pains in the joints. The second form consists of suppurative arthritis involving several joints. The third form consists of serous polyarthritis resembling acute articular rheumatism." It is further stated that " in very exceptional cases they constitute the first sign of typhoid septicaemia so as to merit the title of arthro-typhoid suggested by Robin and Leredde." The case of a patient aged 46, is cited. His principal symptoms for the first fortnight of the disease were fever and pains in the joints, which were attributed to acute articular rheumatism, although they were not relieved by sodium salicylate. Some of the joints were merely painful, others were red and swollen. It was only between the 15th and 21st day that the typhoid symptoms developed and the Widal reaction was found to be positive. With reference to the above the following case treated in this hospital would appear to be of some interest. A railway engineer, aged about 28 years, was brought to the hospital on 22nd May, 1927, for fever and severe pains in the joints. The temperature was high, 103? 104?F. and the knee joints, ankles and one wrist were affected. The knees were more affected than the other joints. A faint systolic murmur was heard at the mitral area, but this disappeared after a few days. Salicylates and alkalies were prescribed, and local applications were made, but there was no effect either on the temperature or the joint pains. The shoulders and the wrists were affected later on. As the temperature was keeping up steadily, suspicions of typhoid were raised. There were no abdominal symptoms. The patient was put on chlorine mixture and guaiacol and hydrarg. c. creta powders. His blood was sent for the Widal reaction and was reported positive. The temperature continued ranging between 101?103?F. till the 5th June, and then came down gradually to normal on the 11th June. After this he had subsultus tendinium as the temperature went down. The interest of the case lies in the fact that the patient had all the signs of acute rheumatism in the beginning, and a diagnosis of typhoid was only made tentatively and confirmed later on by the Widal test.