Typhoid fever

You Chengcheng
Dept. of pathology
China Three Gorges University

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 Contents
 Introduction
 Pathogenesis

 Pathological changes

 Symptoms

 Complication

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First, let me tell
a story of typhoid Mary
……

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Prevalent in the third world country
Outbreaks are rare,but in some areas such as in
Indonesia and New Guinea,it ranks among the 5
most common causes of death
Bacterial infection of the intestinal tract and
occasionally the bloodstream
The ileum is most affected

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Mononuclear Phagocytic System(MPS):
Monocytes and its derivations
mononuclear cells (blood)
macrophages (connective tissue)
kupffer cells (liver) ………..

Typhoid fever is characterized by macrophages

Proliferation of MPS, which are particularly
predominant in ileum.

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Pathogenesis
The germ that causes typhoid is a unique
human strain of salmonella called Salmonella
typhi

Gram negative bacillus.

O-Ag, H-Ag, vi-Ag

(Widal reaction)
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Infection source：typhoid fever patient and carrier
route of transmission： fecal-oral route
susceptible population:children and young people

Food, fly, finger, water

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 second contact
First contact Whole body Lymph tissue
Salmonella typhi Proliferate in Septicaemia
in ileum
ileum tissue bacteremia Toxemia
Contaminanted food Gall
bladder
Hyperplasia stage
Excretion (1w)

Necrosis and ulceration

Incubation period(10 d) (2w)

Healing
(1w) 8
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Pathological changes
Hallmark histologic finding:the infiltration of tissue
by typhoid cells

typhoid cells:large macrophages contain

Phagocytized erythrocytes, lymphocytes,
bacteria and necrotic cellular debris

Typhoid nodule (typhoid granuloma) :

the aggregates of typhoid cells

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Typhoid nodule can present in the lymph tissue
of small intestine, mesenteric lymph node, the
liver, spleen and marrow,
its typical changes often occur in the lower
part of ileum , especially in the Peyer‘s
patches and Isolated lymphonodulus.

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typhoid cell

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typhoid cell

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typhoid cell

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typhoid cell 15
Typhoid granuloma

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Intestinal pathological changes
The principal lesions are those of lymphoid
tissue of terminal small intestine.
(1) Hyperplasia Stage ( Peyer’s patches)
(2) Necrosis Stage;
(3) Ulceration Stage;
(4) Healing Stage.
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Hyperplasia stage：
the 1st w after onset
lymphoid tissue swelling protrude out the mucosa ,
looks like cerebral convolution

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Hyperplasia stage

Showing the hyperplasia

of Peyer’s patches of
ileum, which is button-like
elevation

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Hyperplasia stage

looks like
cerebral convolution

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 Hyperplasia stage

looks like
cerebral convolution

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Hyperplasia stage

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Microscopy:

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•Necrosis stage： the 2nd w after onset
multi-focal necrosis in lymphoid tissue

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 Ulceration stage：
the 3rd w after onset，
necrosis tissue fall off and ulcer formation,
longitudinal ulcer is parallel with the axis of
intestinal canal , deep to the muscularis layer
and involve the artery ,which will result in bleeding

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 ulceration stage

Key features：
• Round or oval
•Elevated margins
•Uneven bottom
•Parallel to the axis of intestine

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ulceration stage
Key features：
• Round or oval
•Elevated margins
•Uneven bottom
•Parallel to the
axis of intestine
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ulceration stage

ulcer 29
 Difference
Typhoid fever Tuberculosis

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Healing stage：
the 4th w after onset
Granulation tissue proliferation ,
scar formation

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Changes in other MPS

Typhoid nodule formation and ulceration in

mesenteric lymph node, the liver, spleen
and marrow.

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 Lesions in other organ

Gall bladder: carrier

Heart: slower pulse
Kidney: Albuminuria
Skin: rose rashes

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 SYMPTOMS
 Fever (some as high as 40 Degrees)
 Weakness
 Headache
 Loss of Appetite
 Stomach pains
 Rose Rashes
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Complications:

intestinal bleeding
intestinal perforation
lobular pneumonia

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Bacillary Dysentery

Chengcheng You
Dept. of pathology
China Three Gorges University
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Bacillary dysentery is an acute bacterial infection
caused by the genus Shigella resulting in colitis
affecting predominantly the rectosigmoid colon.

The disease is characterized by diarrhea, dysentery,

fever, abdominal pain, and tenesmus.

It is usually limited to a few days.

Mainly occur in infants and young children

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•Pathogen
Shigellae are nonmotile
gram-negative bacilli belonging
to the family Enterobacteriaceae

•Four species:
S. dysenteriae (group A),
S. flexneri (group B),
S. boydii (group C),
S. sonnei (group D). 40
Incidence
•most cases of shigellosis occur in children of
developing countries

•S. flexneri is the predominant species

•Children between 1 and 4 years old

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• Infection source： patient and carrier
• route of transmission： fecal-oral route
• Susceptible population:children and young people
• seasonal patterns: autumn and summer

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 PATHOGENESIS
•organisms traverse the small bowel, penetrate
colonic epithelial cells and multiply intracellularly

•acute inflammatory response

•pseudomembranous type of colitis

•Epithelial cells containing bacteria are lysed,

resulting in superficial ulcerations and shedding
of shigella organisms into stools

•Diarrhea results because of impaired absorption of

water and electrolytes by the inflamed colon 43
 Feature
 Location:
predominantly the rectosigmoid colon

 Clinical type :
 Acute bacillary dysentery
 Chronic bacillary dysentery
 Toxic bacillary dysentery

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 Acute bacillary dysentery

Mucus secretion increase

Serous inflammation diffuse hyperemia
erosion

Fibrinous inflammation Map-like ulcer

bloody mucoid diarrhea

healing
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 Acute bacillary dysentery
•Gross: Affect the colon, producing an acute
inflammation with diffuse hyperemia、
edema and multiple superficial ulcers.

•Pseudomembrane formation: exudate fibrin,

neutrophils, necrotic debris, bacteria

•MI: epithelial cell necrosis, fibrin exudation

monocytes and neutrophils infiltration
abscess formation

•The lesions are often self-limited and can

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recover completely
Pseudomembrane

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pseudomembranous
inflammation

Gross: showing the

pseudomembrane
and irregular ulcers

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bacillary dysentery

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Microscopy:

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Bacillary dysentery
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 Complications

•Intestinal Bleeding
•Intestinal Perforation(seldom)

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 Clinic Feature
 Symptoms begin with sudden onset of high grade
fever, abdominal cramps and watery diarrhoea.
 Subsequently diarrhea become mucoid, of small
volume and mixed with blood. This is accompanied
by abdominal pain and tenesmus.
 Physical signs are those of dehydration beside
fever, lower abdominal tenderness and normal or
increased bowel sounds.
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 Chronic bacillary dysentery
•lasting more than 2 months ,
infected by S.flexneri(福氏菌).
•Clinical features：
Mild symptom of abdominal pain ,diarrhea
Infectious source
•pathological changes：
① chronic ulcers;
② forming polypi ;
③ intestinal wall are fibrosis. 56
 Toxic bacillary dysentery
Children at the age of 2-7 years old are sensible
most are result from S.sonnei and S.flexneri.
clinical features：
① toxic symptom all over the body:
Toxic shock、respiratory or circulation failure.
② intestinal symptom: mild
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Questions for the class

1.What kind of inflammation is involved in

bacillary dysentery?

2.The definition of typhoid granuloma

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