Typhoid Fever

Etiology

Typhoid fever, also called enteric fever, is caused by an obligate intracellular bacillus called Salmonella
typhi and Salmonella paratyphi and resides within mononuclear phagocytic cells of lymphoid tissues.

Infection by S. typhi is more common in endemic areas, where children and adolescents are most often
affected. By contrast, S. paratyphi predominates in travelers and those living in developed
countries.Humans are the sole reservoir for S. typhi and S. paratyphi, and transmission occurs from
person to person or via contaminated food or water.

Pathogenesis

Salmonellae possess virulence genes that encode a type III secretion system capable of transferring
bacterial proteins into M cells and enterocytes. The transferred proteins activate host cell Rho GTPases,
thereby triggering actin rearrangement and bacterial uptake into phagosomes where the bacteria can
grow. Salmonellae also secrete a molecule that induces epithelial release of a chemoattractant
eicosanoid that draws neutrophils into the lumen and potentiates mucosal damage.

S. typhi is spread through contaminated food, drink, or water. If you eat or drink something that is
contaminated with the bacteria, the bacteria enter your body. They travel into your intestines, and then
into your blood. In the blood, they travel to your lymph nodes, gallbladder, liver, spleen, and other parts
of the body.

Clinical features

Acute infection is associated with anorexia, abdominal pain, bloating, nausea, vomiting, and bloody
diarrhea followed by a short asymptomatic phase that gives way to bacteremia and fever with flulike
symptoms. It is during this phase that detection of organisms by blood culture may prompt antibiotic
treatment and prevent further disease progression.

Cultures are positive in 90% of cases during the febrile phase .Without such treatment, the febrile phase
is followed by up to 2 weeks of sustained high fevers with abdominal tenderness that may mimic
appendicitis. Rose spots, small erythematous maculopapular lesions, are seen on the chest and
abdomen.

Systemic dissemination may cause extraintestinal complications including encephalopathy, meningitis,

seizures, endocarditis, myocarditis, pneumonia, and cholecystitis.

Possible complications that may develop include:Intestinal hemorrhage (severe GI bleeding),Intestinal

perforation,Kidney failure and Peritonitis.