TYPHOID FEVER:

○ Definition
○ Etiology
○ Pathogenesis
○ Morphology
○ Clinical features
○ Diagnosis
➢ It is a bacterial infection that spreads through contaminated food and
water.
➢ Typhoid fever also referred as ENTERIC FEVER.

ETIOLOGY:

● It is caused by SALMONELLA ENTERICA and its two subtypes, typhi

and paratyphi.

● Humans are the sole reservoir for S.typhi and S.paratyphi; transmission
occurs from person to person or via food or contaminated water
● The majority of cases in endemic countries are due to S.
typhi, while infection by S. paratyphi is more common
among travelers, perhaps because they are often
vaccinated against S. typhi

● In endemic areas, children and adolescents are affected

most often, but there is no age preference in non-endemic
countries.

● Gallbladder colonization with S typhi or S. paratyphi may be

associated with gallstones and a chronic carrier state.
PATHOGENESIS:
Ingestion of contaminated food or water
Invade small intestine and enter bloodstream
Carried by WBC in liver, spleen, bone marrow
Multiply and re-enter the Bloodstream
Invade the lymphatic and blood vessel
Causes systemic reactive hyperplasia of phagocytes
and lymphoid tissue
GROSS FEATURES:

● Terminal ileum is most affected

segment.
● Oval ulcers over peyer’s patches.

● Base of ulcer is black due to

sloughed mucosa.
● Intestinal perforation is
one of the most dreaded
and common
complication of typhoid
fever.
● Ulcers are formed due to
Necrosis in the Peyer’s
patches.
MORPHOLOGY:
● Salmonella infection causes Payer patches in the terminal
ileum into sharply delineated, plateau-like elevations up to 8 cm
in diameter.

● Draining mesenteric lymph nodes are enlarged.

● Neutrophils accumulate within the superficial lamina propria

together with macrophage containing bacteria, red cells, nuclear
debris, lymphocytes and plasma cells.
MICROSCOPIC FEATURES:
● Oval ulcers over peyer’s patches
● Macrophage, lymphocytes and plasma
cells are seen.
CLINICAL FEATURES:
■ Acute infection results in anorexia, abdominal pain,
bloating, nausea, vomiting, and bloody diarrhea
followed by fever with flu-like symptoms.

■ Systemic dissemination may cause extraintestinal

complications including encephalopathy, meningitis,
seizures, endocarditis, myocarditis, pneumonia, and
cholecystitis
■ Abdominal tenderness may mimic appendicitis.

■ Rose spots, small erythematous maculopapular

lesions, develop on the chest and abdomen.

■ Patients with sickle cell disease are particularly

susceptible to Salmonella osteomyelitis.
DIAGNOSIS:
Made by
1.Blood culture
2.Stool culture
3.Duodenal culture
4.Serology - WIDAL TEST
WIDAL TEST:

“A test involving agglutination of typhoid bacilli when they are

mixed with serum containing typhoid antibodies from an
individual having typhoid fever; used to detect the presence of
Salmonella typhi and S. paratyphi”.

Agglutination in dilution of and more than 1:320 is confirmatory

of ENTERIC FEVER.
Reference:
1. Robbins textbook of pathology
2. Harsh Mohan Textbook of pathology