Typhoid Enteritis

Content below is from a textbook reference chapter (Sabiston Ch50 - Infectious Enteritis & Small Bowel Neoplasms), not primary literature — treat as background/orientation rather than critically-appraised evidence.

Epidemiology

Typhoid fever remains a significant problem in developing countries, most commonly areas with contaminated water supplies and inadequate waste disposal. Roughly 21.6 million people worldwide develop typhoid fever annually, with an estimated 200,000 deaths/year; children and young adults are most often affected. Improvements in sanitation have decreased incidence in industrialized countries — most US cases arise in international travelers. Unrecognized and untreated typhoid fever is a life-threatening illness with significant long-term morbidity.

Pathophysiology

Caused primarily by Salmonella typhi. Organisms penetrate the small bowel mucosa after oral ingestion of the typhoid bacillus, making their way rapidly to the lymphatics and spreading systemically. Hyperplasia of the reticuloendothelial system (lymph nodes, liver, spleen) is characteristic. Peyer patches in the small bowel become hyperplastic and may subsequently ulcerate, complicated by hemorrhage or perforation.

Diagnosis

Confirmed by isolating the organism from blood (positive in 90% of patients during the first week of illness), bone marrow, and stool cultures. Elevated titers of agglutinins against O and H antigens (Widal test) was historically used but is nonspecific and no longer an acceptable clinical method. PCR analysis for S. typhi is unpredictable. Combining blood and urine cultures achieved a sensitivity of 83% and reported specificity of 100% in one study. Indirect hemagglutination, indirect fluorescent Vi antibody, and indirect enzyme-linked immunosorbent assay for IgM/IgG antibodies to S. typhi polysaccharide are promising, but success rates vary greatly across the literature.

Treatment

Typhoid fever and uncomplicated typhoid enteritis are treated with antibiotics. If a patient presents with clinical symptoms and has been in an endemic area, broad-spectrum empirical antibiotics should be started immediately — treatment should not be delayed for confirmatory tests, since prompt treatment drastically reduces complication and fatality risk. Antibiotic therapy should be narrowed once more information is available. Chloramphenicol was initially the mainstay of treatment in the 1950s, but widespread antibiotic resistance has since occurred; the most widely used agents currently are fluoroquinolones and third-generation cephalosporins.

Complications requiring potential surgical intervention

Hemorrhage and perforation are the main complications requiring possible surgery.

• Hemorrhage: reported as high as 20% in one series, though this figure has decreased with antibiotic availability. Transfusion is indicated and usually suffices; laparotomy is rarely required, reserved for uncontrollable, life-threatening hemorrhage.
• Perforation: occurs through an ulcerated Peyer patch in approximately 2% of cases. Typically a single perforation in the terminal ileum — simple closure is the treatment of choice. Multiple perforations occur in about 25% of cases and may require resection with primary anastomosis or exteriorization of the intestinal loop.

Open items / gaps

• No primary literature yet in the wiki on typhoid enteritis specifically — this page is entirely textbook-reference-derived.
• Vaccination for typhoid prevention is not discussed in this chapter chunk.