pathophysiology of typhoid fever
is complex and occurs throughseveral stages.Once, the bacteria(Salmonella typhi),survives the acidity of the stomach, itreaches the intestine and invades the Payer`s patches of the intestinalwall.Payer`s patches are the clusters of cell primarily composed of Macrophages are specialised cells that are essential to kill any bacteria.But,Salmonella Typhi is unaffected by these macrophages but, start survivewithin the macrophage itself.So , during this asymptomatic incubation period of 7-14 days, the bacteriaspread throughout the reticuloendothelial system of liver,spleen,gallbladder,and bone marrow. The first week of symptomatic period is characterised by progressiveelevation of temperature.In the second week, the victim may experience abdominal pain, spleenenlargement and notice Rose spots on his skin. The third week is more intense as the bacteria start causing necrosis of thePayer`s patches of the intestine which leads to perforation andbleeding.This is the terminal stage,if, left untreated, death is imminent. That`s why,it is also called "enteric fever".Enteric which means, intestine.
After ingestion by the host,
invades through the gut and multiplies within themononuclear phagocytic cells in the liver, spleen, lymph nodes, and Peyer patches of the ileum.After successfully passing through the stomach, any
subspecies may be phagocytizedby the gut's intraluminal dendritic cells, causing inflammation that leads to diarrhea. Itsspecialized fimbriae adhere to the epithelium that overlies Peyer patches. Peyer patches aregrossly visible aggregates of 5-100 lymphoid follicles in the small bowel submucosa; thesepatches are larger and more numerous distally. They are the primary mechanism for samplingantigens in the gut and initiating response.
enters them via 1 of 3 pathways.Intraluminal dendritic cells may infiltrate through the gut epithelium while carrying thebacterium. M cells may transport it as well. Immobile and interspersed among regularenterocytes in Peyer patches, M cells are epithelial cells that mature into professionalphagocytes. They phagocytize bacteria such as
and present them to macrophagesand T cells in the lamina propria. Most interestingly,
may convert normallynonphagocytic epithelial cells into bacterially-mediated endocytosis (BME).