Typhoid Fever

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Typhoid / Enteric Fever

Enteric fever is an acute infection of the salmonella typhi (typhoid fever) or salmonella paratyphi ( paratyphoid fever) and may be food poisoning.


ETIOPATHOGENESIS : The typhoid bacilli are ingested through contaminated food and water. Initially it is asymptomatic and incubation period is about 2 weeks. The bacilli invade the lymphoid follicles and peyer's patches of small intestine and proliferate.

MORPHOLOGICAL FEATURES : The lesions are observed in intestine and many other organs -
1. Intestinal lesions
Grossly : Terminal ilium is affected mostly but lesions may be seen in the jejunum and colon. Peyer's patches show oval typhoid ulcers their long axis along the length of the bowel. The base of the ulcers is black due to sloughed mucosa. The margins of the ulcers are slightly raised due to oedema and cellular proliferation. The regional lymph nodes are enlarged.
Microscopically : There is hyperaemia, oedema and cellular proliferation (consisting of phagocytic histiocytes, RBCs,lymphocytes and plasma cells). Though enteric fever is an example of acute inflammation with neutropenia, and lymphocytosis in the peripheral blood.
Typhoid fever, Enteric fever, Aasgaduli, Aas_study, Aasstudy, GIT disease, Gastro-intestinal disease
A. Typhoid ulcers in the small intestine, B. Blood picture in typhoid fever with neutropenia and relative lymphocytosis.


2. Other lesions : Besides the intestinal lesions, other lesions are -

  1. Mesenteric lymph nodes - Haemorrhagic lymphadenitis.
  2. Liver - Foci of parenchymal necrosis.
  3. Gallbladder - Typhoid cholecystitis.
  4. Spleen - Splenomegaly with reactive hyperplasia.
  5. Kidneys - Nephritis.
  6. Abdominal muscles - Zenker's degeneration.
  7. Joints - Arthritis.
  8. Bones - Osteitis.
  9. Meninges - Meningitis.
  10. Testis - Orchitis.
Persistence of organism in the gallbladder and urinary tract resulting in, it come out with urine and faeces and create a 'carrier state' which is a source of infection to other.
COMPLICATIONS : Intestinal lesions of typhoid -
  1. Perforation of the ulcers
  2. Haemorrhage.
CLINICAL FEATURES : 
  1. Disease continuous rise in temperature.
  2. 'Rose spots' on the skin are observed.
  3. Immunological reactions (Widal's test) begins after 10 days and it reach to peak level at the end of 3rd week. 



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