Typhoid: Pathogenesis, Clinical features and Complications.


Typhoid: Pathogenesis, Clinical features and Complications.

Typhoid fever is also known as Enteric fever and is of bacterial origin. It is caused by infection with Salmonella typhosa/ Slmonella typhi.

 Salmonella paratyphi A and Salmonella paratyphi B are responsible for Para typhoid fever. Symptoms are mild and complications are less in paratyphoid fever.

Route of Transmission-

The disease is mainly transmitted by oral route due to ingestion of contaminated food, water, milk etc. by flies or carriers.

Stool of infected patient is the main reservoir of infection.

Incubation  Period- 

10 to 14 days

Pathogenesis-

The infective organism enters the body through oral route; it enters through lymphoid tissue either Tonsillar or intestinal. If it survives the acid barrier of gastric juice it passes on to duodenum. Then it leaves the intestine via the lymphatics by way of payer's patches and solitary lymphoid follicles. Then it passes the lymph node barrier and reaches the blood through thoracic duct. At this stage a transitory bacteraemia occurs and the bacterias and rapidly removed by the clearing mechanism of Reticulo-endothelial cellsof spleen, liver and bone marrow. They multiply in these organs and in Reticulo-endothelial cells of mesenteric lymph nodes during the incubation period.
At the end of incubation period sedary bacteraemia occurs with greater severity, with the onset disease. Reinvasion of intestine occurs after the organism get localized in the gallbladder and intestine. Small intestine and payer's patches are the main sites of ulceration, hemorrhage and perforation.

Clinical features-

The acute condition has duration of 4-5 weeks. Onset is insidious. Temperature rises in stepladder fashion.

First week-

1. Fever
2. Malaise
3. Increasing headache
4. Drowsiness
5. Pain in limbs 
6. Cough
7. Epistaxis 
8. Constipation, in children diarrhea and vomiting. 
9. Puls4 is relatively slower with respect to rise in body temperature (relative Bradycardia).
10. Temperature rises in step ladder pattern, higher in evening than morning.

 End of 1st week/2nd week-

There is high grade fever, around 104°F.
1. Rash- appearances of rashes on upper abdomen and back, they are slightly raised, red rose spot and fades on pressure. Each spot last for 3-4 days.  
2. Spleen is palpable around 7th to 10th day.
3. Diarrhoea- frequency of 6-8/ day, green like pea soup with characteristic smell.
4. Abdominal distension, tenderness.
5. Bronchitis, Rhonchi is heard in lung base.
6. Delirium
7. Hepatomegaly

3rd week (end of 2nd week)-

1. Temperature still very high. Patient become severely ill.
2. Delirium
3. Complications- Intestinal hemorrhage, etc
4. Toxemia increases and patient may land into coma and even die if not treated properly.

4th to 5th week-

1. Temperature gradually falls.
2. Weight gradually increases.
3. If untreated complications like perforation and hemorrhage of ulcerated payer's patches is seen.

Complication of Typhoid fever 

1. Hemorrhage or perforation of ulcerated payer's patches.
2. Cholecystitis
3. Pneumonia
4. Myocarditis
5. Arthritis
6. Osteomyelitis
7. Meningitis/Encephalitis
8. Nephritis
9. Peritonitis
10. Peripheral neuritis (weakness/numbness/pain from nerve damage)
11. cerebellar ataxia (impaired balance/co-ordination)
12. Deafness
13. Alopecia (sudden hair fall with bald patches)

 

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