Typhoid fever pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology


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Innoculation
  • Orofecal transmission
  • Infective dose 1000 to 1 million
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gastrointestinal Infection

Stomach

  • Enters stomach
  • High tolerance for acid
  • Survives PH as low as 1.5

Small intestine

  • Adherence to mucosal cells
  • Invade mucosal M cells overlying payers patches
  • Internalisation in M cells
  • 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
  • Evades immune system
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    Chronic carrier state
    • Resides and multiplies in gall bladder
    • Excretion in urine and stool
     
     
     

    Heterozygous advantage

    It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. The CFTR protein is present in both the lungs and the intestinal epithelium, and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium.

    References

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