Infectious diseases. Typhoid fever. Epidemiology. Pathogenesis. Pathomorphology (most important)

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Infectious diseases. Typhoid fever. Epidemiology. Pathogenesis. Pathomorphology (most important)

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3. Typhoid fever. Epidemiology. Pathogenesis. Pathomorphology

Typhoid fever is an acute infectious disease caused by typhoid bacilli. Characteristic features are the predominant lesion of the lymphatic apparatus of the small intestine, high fever, severe intoxication and bacteremia.

Epidemiology. The transmission of the pathogen is carried out by contact-household, water, food, and also by flies.

Pathogenesis. Typhoid infection is always accompanied by clinical symptoms. Virulent typhoid pathogens suppress oxidative processes in neutrophils at the final stages of phagocytosis, saving themselves from destruction. Monocytes in the initial period of infection, unable to destroy the pathogen, transport it to the mesenteric lymph nodes and other parts of the reticuloendothelial system, in which it multiplies. Inflammatory changes occur in the lymph nodes, in the liver and in the spleen. Pathogens quickly penetrate the wall of the upper small intestine without causing pronounced inflammatory changes, and from there into the general circulation. A short septicemia causes infection of many organs of the reticuloendothelial system, in the cells of which microorganisms concentrate and multiply. Secondary bacteremia is usually more prolonged and leads to the defeat of many organs. The gallbladder is damaged by the hematogenous route and through the bile duct system.

The outer shell of the cell wall of Salmonella is a complex of lipopolysaccharides

(endotoxin). The accumulation of typhoid bacteria and the release of endotoxin cause characteristic histological changes in the intestine, liver, skin, and other organs.

Cellular immunity mechanisms play an important role in resistance to typhoid fever. A significant decrease in the number of T-lymphocytes occurs in patients with especially severe forms of this disease.

Pathomorphology. Morphological changes in typhoid infection in young children are less pronounced than in adults or children of older age groups. Lymph nodes of the mesentery, liver and spleen are usually plethoric, they revealed foci of necrosis. Characteristic features include reticuloendothelial hyperplasia with proliferation of monocytes. Swollen liver cells. Signs of inflammation and necrotic changes on the intestinal mucosa and in the lymphatic formations of its walls are expressed. A mononuclear reaction also develops in the bone marrow, which also shows foci of necrosis. Inflammatory changes in the walls of the gallbladder are focal and unstable. Bronchitis is observed in most patients with typhoid fever. Inflammatory processes can be manifested by pneumonia, osteomyelitis, abscesses, purulent arthritis, pyelonephritis, endophthalmitis and meningitis. Typhoid bacteria can be found in all organs.

Author: Pavlova N.V.

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