Typhoid fever pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Pathogenesis

The pathogenesis of typhoid fever consists of following sequence of events.

Innoculation

  • Orofecal transmission.
  • Infective dose 1000 to 1 million organisms.


Gastrointestinal Infection

Stomach

  • Bacterium enters stomach.
  • Survives pH as low as 1.5

Small intestine

  • Adherence to mucosal cells via special proteins.
  • Invade mucosal M cells overlying peyer's patches
  • Internalisation in M cells of ileum.
  • Translocation to underlying lymphoid tissue and draining lymph nodes.

Systemic spread

  • Dissemination of S.typhi to reticuloendothelial system.
  • Spreads via lymph and blood
  • Replication within reticuloendothelial system such as spleen, liver, bone marrow.
  • Evades immune system by hiding intracellularly within macrophages.

Chronic carrier state

  • Resides and multiplies in gall bladder
  • Excretion in urine and stool infecting other individuals.


References

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