FIRST CLINICOPATHOLOGIC

CONFERENCE

ANNALYN S. DA-ANOY , M.D.

JOANNE MARIE RODRIGUEZ , M.D. , D.P.S.P.
A-089
 UPON EVISCERATION:
• SEGMENT OF ILEUM AND CECUM
– Approx 1.5Liters of clotted blood
24 YO MALE , CC FEVER , BORN IN LEYTE

NON SPECIFIC SIGNS AND SYMPTOMS

FEVER
TYPHOID BACILLI FOOD AND WATER
CONTAMINATION

STOMACH

ABILITY TO PENETRATE
THE EPITHELIAL CELLS

RAPIDLY TAKEN UP
BY MACROPHAGES

SMALL INTESTINE
 MESENTERIC THORACIC
SMALL INTESTINE LYMPH DUCT
NODES

CARRIED BY
MACROPHAGES

BLOODSTREAM
END OF INCUBATION PERIOD

TRANSIENT OR PRIMARY BACTEREMIA

BRIEF BACTREMIC PERIOD (NOT DEPENDENT ON THE
AMOUNT OF BACILLI PRESENT)
CMI TAKES LONGER TO DEVELOP

NON SPECIFIC SIGNS AND SYMPTOMS

MAY MIMIC MOST OF INFECTIOUS DISEASE
LEUKOCYTOPENIA

FILTERED BY FIXED
MACROPHAGES IN THE RES
(LIVER , SPLEEN)
 SECONDARY BACTEREMIC PHASE
CONTNUOUS MULTIPLICATION OF TYPHOID BACILLI IN
MACROPHAGES (LIVER , SPLEEN AND BONE MARROW)

DISEASE OF THE RES

AGGREGATES OF
CMI MOUNTS A STRONG MONONUCEAR CELLS
INFLAMMATORY RESPONSE FORMING
GRANULOMATOUS LESIONS

MENINGOENCEPHALITIS
BRAIN SEIZURE

ADRENAL

TYPHOID PANCREAS

NODULE SPLEEN
SPLENOMEGALY

1.LESS DISTINCT GRANULOMA

MESENTERIC LYMPH NODES ,
COLON AND ILEUM
2. MORE PRONOUNCED NECROSIS
3. ERYTHROPHAGOCYTOSIS

ILEUM
HYPERPLASIA OF PEYERS PATCHES IN THE ILEUM

GRANULOMATOUS LESIONS MAY NECROTIZE

SECONDARY TO OCCLUSION OF SMALLER VESSELS
(MICROTHROMBI FORMATION)

NECROTIZING LESIONS PROGRESSIVELY COALESCE

ULCERATION IN THE INTESTINAL WALL (ILEUM)

CONCOMITANT SCHISTOSOMA INFECTION

LIVER , LUNGS , PANCREAS , COLON AND MESOCOLIC LYMPH NODES
SCHISTO OVA------DELAYED TYPE OF HYPERSENSITIVITY REACTION-----GRANULOMA FORMATION
SURROUNDING THE SCHISTOSOMA OVA WHICH LATER ON REPLACED Y FIBROSIS

OVERLOADING OF THE RETICULOENDOTHELIAL

SYSTEM
OVERLOADING OF THE RETICULOENDOTHELIAL
SYSTEM

SUSCEPTIBILITY TO SALMONELLA SEPTICEMIA

HYPOTENSION
BRADYCARDIA NOT IMPROVED BY FLUID CHALLENGE

DAY 10:
SEPTIC SHOCK DEATH
 FINAL ANATOMIC DAGNOSIS
I. SALMONELLA SEPTICEMIA
A. MULTIPLE TYPHOID NODULES
a. EROSION , ULCERATION AND HEMORRHAGES ,
ILEUM
b. LIVER
c. BRAIN
d. KIDNEYS
e. COLON
f. PANCREAS
g. ADRENALS
h. MESOCOLIC LYMPH NODES
FINAL ANATOMIC DIAGNOSIS
A. POST MORTEM CULTURE OF ILEAL ULCERS , BILE OF
THE GALLBLADDER , SPLENIC PULP , POSITIVE FOR
SALMONELLA TYPHI GROWTH
B. CHRONIC GRANULOMATOUS INFLAMMATION AND
SCHISTOSOMA OVA INVOLVING THE LIVER ,
PANCREAS , COLON AND MESOCOLON LYMPH NODES
, CONSISTENT WITH SCHISTOSOMA JAPONICUM
INFECTION
C. REACTIVE SPLENITIS

I. BRONCHOPNEUMONIA , BILATERAL
II. HEPATOMEGALY (1,750 GRAMS)
 CAUSE OF DEATH
SEPTIC SHOCK SECONDARY TO
SEVERE SALMONELLA TYPHI
BACTEREMIA.
 Salmonella enterica serovar typhi

• Exclusive human pathogen

• Gram negative flagellated bacilli
• Non-sporulating facultative anaerobe
• Reduces nitrate to nitrite
• Synthesizes peritrichous flagella when
motile
• Has somatic O, flagellar H, envelope K
and surface virulence (Vi) antigens and
LPS endotoxin
Pathophysiology and mode of infection:

liver

Invades spleen
through gut Multiplies within Colonizes
mononuclear lymph nodes
phagocytic cells.
http://www.healthygenius.com Ulcers
peyer patches
Ingestion of S. Peritonitis
typhi by host

cts
Inflammation

du
and diarrhea
e

le
urin

Bi
In receptor-mediated
phagocytosis
ol,

In gut epithelium: Bacteria-

Sto

mediated endocyosis (BME). submucosa:

Macrophage

Enters
Bile ducts
bloodstream
Gallbladder

Infect other hosts

Apoptosis
Symptoms and diagnosis:
• First symptoms include: loss of appetite,
fever, headache, joint pain, sore throat,
constipation (or, less commonly,
diarrhea), and abdominal pain and
tenderness.
• As the illness progresses, fever remains
high, and the person may become
delirious. Sustained fever is often
accompanied by a slow heartbeat and
extreme exhaustion.
Symptoms and diagnosis:
• During the second week and last 2 to 5
days: 10% of infected people get clusters
of small, pink spots on the chest and
abdomen. Intestinal bleeding or
perforation occurs in 3 to 5% of infected
people.
• Pneumonia may develop
• Infection of the gallbladder and liver
Symptoms:

http://www.indstate.edu/thcme/micro/GI/GIpathogens/
Symptoms and diagnosis:
• At the final stage, a blood infection (bacteremia)
occasionally leads to infection of bones
(osteomyelitis), heart valves (endocarditis),
kidneys (glomerulitis), the genitourinary tract
and tissues covering the brain and spinal cord
(meningitis).
• Infection of muscles may lead to abscesses
(collections of pus).
• Although the history and symptoms of illness
may suggest typhoid fever, the diagnosis must
be confirmed by identifying the bacteria in
cultures of blood, stool, urine, or other body
fluids or tissues.
 POSSIBLE SPECIMENS TO BE
SUBMITTED FOR CULTURE
• BLOOD-1ST week of infection
• URINE- 2ND week of infection
• STOOL- 3RD week of infection
Chronic carrier state:
• 1-4% of untreated patients become chronic
carriers.
• Stool carriage is more frequent in people
with preexisting biliary abnormalities and
these people have a greater incidence of
cholecystitis.
• Greater risk for carcinoma of the gallbladder
• 6-fold increase in the risk of death due to
hepatobiliary cancer.