Relation to constipation: Enteric or typhoid fever

Enteric or typhoid fever

In relation to constipation, typhoid fever or enteric fever may be a condition that is so significant to note. Among its prominent symptoms is constipation alternating with a period of severe diarrhea that can result to complications such as typhoid ileitis (or paralysis of the ileum due to the enteric fever), and even death.

Enteric fever is very common in developing countries, particularly in areas where hygiene and sanitation are questionable. This condition can be induced by any Salmonella species, which are bacteria commonly found in poorly-cooked meat, or in any contaminated food or drink. Enteric fever becomes known as typhoid fever if the culprit is the Salmonella typhi serotype.

The pathogenesis of Salmonella is rather alarming – in contrast to most parasites which are extracellular, these bacteria are classified as an intracellular pathogen. Most often, these organisms cross the epithelial barrier in the small intestines, and begin to multiply at areas such as in the Peyer's patches, the spleen, mesenteric lymph nodes, and may even go as far as to the gallbladder, the lungs, kidneys, and ultimately, the central nervous system. Symptoms frequently occur within 5-14 days after ingestion of contaminated material.

The disease starts out at the prodromal phase, wherein respiratory symptoms such as cough and sore throat, as well as nonspecific symptoms such as headache, abdominal pain and malaise, simultaneously occur. Constipation is already present even at the prodromal stage. Fever is also present, gradually ascending in a stepwise pattern.

About a week after infection, the infected individual becomes increasingly exhausted and ill, and it is usually on the 7th to 10th day that the fever reaches a plateau. Marked constipation is present, though in some cases “pea-soup” diarrhea is also prominent. If treated early, the patient may get well after 7-10 days, with gradual improvement. In the beginning there are less physical findings, but as time progresses, more gastrointestinal symptoms such as enlargement of the spleen can occur. The meninges of the brain might even get involved, although to a milder extent. Rashes, also called as Rose' spots, begin to surface at approximately during the second week of the disease. Decreased heart rate can also be noted. These are expected physical findings during the course of the disease, and afterwards the patient is expected to gradually recover. However, in the absence of signs of improvement, it is the complications that could set in that are most feared.

Typhoid fever can cause deaths in 2% of cases. And in 75% of these deaths, the complications are to blame! Systemic symptoms begin to manifest strongly if the condition is untreated. In fact, this can eventually cause intestinal hemorrhage (as shown through signs of shock) or intestinal perforation most likely on the third week. Due to the high mortality rates associated with enteric fever, measures on prevention are currently being exercised. A vaccine was formulated for this purpose but this is however not that effective, and only advisable for travelers who are going towards endemic areas. Still, despite the presence of vaccines, the best methods for prevention lie in proper sanitation and hygiene.