Pathophysiology of Typhoid fever (book based)

Source: Typhoid Fever: Pathogenesis and Disease by Deborah house et al

Non Modifiable factors Modifiable factors

Race: living in endemic Drink water contaminated by

countries(South East Asia) sewage that contains S. typhi
Fecal oral route contamination of
water/food

Open sewage accessible to

Insect land on the sewage

Pick up the bacteria

Contaminated food/water by
humans
Swallowed Salmonella typhi

inflammatio
n
Head down to digestive tract
Fever
Diaphoresis
Survived the activity of the Headache
Chills
Reach the intestinal mucosa (causing Sore throat
no lesion) Cough and
mucus
Use their special production
fimbriae weakness

Fimbriae adhere to epithelium

over clusters of lymphoid tissue
in the ilium
Invade epithelial cells by
bacterial mediated
endocytosis

An adherent and invasive

phenotype is activated
 V1 capsular antigen promote
expression of the phenotype

Delivers bacterial proteins

from the Salmonella cytosol
into the host cell
Induce changes within host
cell and promote bacterial

Avoid encapsulation by
lysosomes

Intracellular multiplication

Secretory response in the

Diarrhea
epithelium and ↑ neutrophils
Easy
fatigability
Paleness
Lack of acute inflammation and
neutrophils

Allow S. typhi to invade into

the deeper tissues of gut
lumen

Bacteria carried through mesenteric

lymph nodes

Carried through the thoracic

duct

Carried to the lymphatic

system

Carried through the

reticuloendothelial system

Lymph nodes Spleen/ Liver Bone

marrow

Peyer's Inflammation Inflammatio

patches n
inflammation
 Become Splenomegal ↑ cytokines
hyperplastic y/
and Hepatomegal
hyperaemic Induce nitric
Distended oxide
abdomen
Abdominal pain Contribute to
Constipation immune
Anorexia mediated
Nausea cytotocity
Vomiting
Eliminate
hematopoietic
cells

Suppress
hematopoiesis

Anemia
Paleness
Body
malaise

Signs and symptoms

1st week
Fever
Headache
Abdominal pain
Rose spots
diarrhea
fatigue
sore throat

Signs and symptoms

2nd week
Fever 39oC
Diarrhea
Fatigue
Abdominal pain
Cough and mucus production