Typhoid Fever: Clinical Significance Of Its Complications To Man’s Health
Abdominal Discomfort In Typhoid Fever
Complications Of Typhoid Fever
Typhoid fever is associated with several complications. The major complications include severe toxemia, peripheral circulatory failure and intestinal hemorrhage and perforation. These are associated with high mortality if untreated.
Intestinal hemorrhage: Intestinal hemorrhage occurs during the second, or more commonly the third week of illness. Mild bleeding which manifests as blood streaking of the feces is seen in 20% cases, but serious bleeding from the ulcerated Peyer’s patches may occur in 2% cases. Unexplained tachycardia, fall in blood pressure and sudden drop in temperature should indicate the onset of intestinal hemorrhage. The signs of hypovolemic shock set in. The patient passes large amounts of clotted and fresh fluid blood along with small amounts of feces. If left untreated, death may occur within hours of the onset of bleeding.
Intestinal perforation: The terminal 50 cm of the ileum is the site of perforation. The onset of perforation may be heralded by the development of vague abdominal discomfort, acute abdominal pain, tenderness over the right iliac fossa, and rigidity. These is sudden fall of temperature. The pain and tenderness over the right iliac fossa worsen. Signs of peritonitis develop from the right iliac fossa and later become generalized. Signs of peritonitis are severe pain, abdominal rigidity and tenderness and absence of peristaltic sounds. Presence of air under the diaphragm and free fluid in the peritoneal cavity becomes evident as the condition progresses.
Secondary infection of the peritoneal cavity leads to increased toxemia. The mortality in untreated cases exceeds 80%. With prompt treatment, the mortality can be brought down to 10% or less.
In those that survive, the peritonitis may become localized and form an abscess, palpable as a mass in the right lower quadrant of the abdomen.
Rose Spots In Typhoid Fever
Relapse And Other Complications
Relapse: In 10 to 20% of cases, one or two weeks after recovery fever may return with all signs and symptoms similar to those observed during the initial illness. Blood cultures may become positive again. Cases partially treated with antibiotics have a greater tendency for relapse and this is seen in stopping antibiotic therapy. Relapses are generally milder than the initial illness, but sometimes, these may be more serious and associated with complications. Usually, only one relapse occurs but sometimes several relapses occur in succession. The presence of antibody levels as indicated by widal titers does not protect against relapse.
Chronic carrier state: Around 3% of subjects develop chronic asymptomatic carrier state with persistent infection in the gall bladder. This complication is seen more in older women. Such persons pass the organisms in stools for long periods and act as sources of infection to others, especially if they are working as cooks or food handlers. Chronic cholecystitis favours the development of carrier state. Sometimes, chronic urinary carrier state may develop, this is more frequent in areas endemic for bilharziasis.
Finally, typhoid fever usually confers lifelong immunity but second attacks may occur in rare cases. The immunity is relative and It can be overcome by a massive infecting dose of the organisms. Immunity is unrelated to the titre of antibodies againsO,H or Vi antigens.
© 2014 Funom Theophilus Makama