Pathogenesis of Typhoid Fever (Enteric Fever)

Transmission by Fecal-Oral Route of Salmonelle Typhii (Causative Agent) A gram Negative Bacilli The payers patches will present it to immune system. Ingestion into stomachSalmonella Typhii can endure the acidity up to ph of 1.5 Salmonella penetrate the epithelial lining of the small bowel Continue to invade into subepithelial tissue

The fimbriae of salmonella attach to the payers patches (lymphoid tissue)

1st week Blood

2nd week Urine

3rd week stool s\\\s

Produce Virulrence factor

By way of phagocytization

Surface Antigen

Endotoxin

Presented to Macrophage

O Somatic

H Flagella

Prevent activation and subsequent deposition of complement factor Increase Resistant

Increase Motility

Vi Carbohydrate Envelope

Inflammation of the heart

Fever

Myocarditis Enter thoracic duct, lymphatic system, liver, spleen, bone marrow, lymph nodes Cannot phagocytize by polymorphonu clear leukocytes

Autorythmic Cells cannot escape the inflammation

Bradycardia

Avoid Neutrophil based inflammation

Within the macrophage the salmonella typhii travels undetected

Multiply and reached to critical density (Infection)

Induce Macrophage to attract macrophage

The Vi prevent the recognition of pathogen

Infected Payers Patches

Inflammation

Ulceration and Necrosis

GI Bleeding, Perforation

Diarrhea and constipation

Peritonitis and Abdominal pain

Reflex Ileus

Pneumoperitonium