<prompt> All are true about typhoid ulcer exceptMainly affects ileumMultiple ulcer and transversePerforation occurs at 3rd wrekPerforation treated by surgery  <response>: Refer Robbins page no Pg 9e 789 Clinical features Classic features are fever, abdominal pain and hematochezia First week of illness: rising stepwise fever associated with chills, although frank rigors are rare Also relative bradycardia or pulse-temperature dissociation is common Second week of illness: abdominal pain develops and rose spots faint salmon- colored macules on the trunk and abdomen may be seen Third week of illness: hepatosplenomegaly, intestinal bleeding and perforation due to ileocecal lymphatic hyperplasia of the Peyers patches may occur, together with secondary bacteremia and peritonitis Perforation is four times more common in males than females Chronic Salmonella carriage is defined as excretion of the organism in stool or urine 12 months after acute infection Diagnosis Classical clinical features above Typhoid fever is diagnosed by blood or stool culture Bone marrow culture is the most sensitive test available 