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Salmonella typhi

Incubation: 10-21 days


Through food or water contaminated by faeces or urine of carrier


Highest incidence ages 5-19

1% become chronic carriers


Causes a systemic septicaemia (also known as Enteric fever)

If organisms escape destruction by gastric acid they can penetrate small bowel and be taken up by mesenteric lymphatics. Then it may enter the bloodstream via the thoracic duct and disseminate to organs

Salmonelli typhi:

  • Can survive and multiple inside macrophages
  • Eventual release back to blood (corresponds with symptom onset
  • Secondary bowel invasion from infected bile
  • Macrophages collect in large numbers
    • In the ileum (= peyers patches)
    • In other organs (=typhoid nodules)

It follows that disorders resulting in decreased gastric acid have increased risk of developing infection. 

Clinical features and Complications

Typhoid clinical features and complications
Typhoid clinical features and complications


  • WCC normal/leukopenia (except with perforation)
  • Patients may haemolyse
  • BC positive (80%n in first week)
  • Stool cultures


  • Fluid and electrolyte balance
  • Chloramphenicol or amoxicillin/cotrimoxazole
  • Steroids
  • Surgery is required for perforations


  • Sanitation and hygiene
  • Vaccine is available- between 50% to 80% protective – recommended for travellers to endemic areas.


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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