Complications of Typhoid Fever
Typhoid fever can cause life-threatening complications including intestinal perforation (occurring in 3% of cases with 39.6% mortality), acute liver failure, and severe dehydration, with young men being particularly vulnerable to perforation. 1, 2
Gastrointestinal Complications
Intestinal Perforation
- Ileal perforation is the most lethal complication of typhoid fever, affecting 0.8% to 39% of patients depending on geographic location and healthcare resources 1, 3
- Young men are disproportionately affected by this complication 1
- Mortality rates from typhoid intestinal perforation (TIP) range from 5% to 80% in resource-poor countries, with an overall mortality of 39.6% 1, 3
- Diagnosis should be made on physical examination in endemic areas, with surgery being preferable to medical treatment 1
- Major determinants of poor surgical outcomes include delayed presentation, severe peritoneal contamination, and inadequate postoperative intensive care 3
Intestinal Bleeding
- Terminal ileum thickening can be visualized on CT imaging, indicating mucosal involvement 2
- Mesenteric lymphadenopathy is a common finding associated with gastrointestinal complications 2
Hepatobiliary Complications
Acute Liver Failure
- Typhoid fever can progress to acute liver failure (ALF), which is exceptionally uncommon but life-threatening 2
- Presents with mixed hepatocellular and cholestatic pattern of liver enzyme elevation 2
- Clinical deterioration can be rapid, with altered mental status, respiratory distress, and escalating MELD scores 2
- Hepatitis and cholestasis are rare sequelae but require intensive monitoring 2
- Porta-hepatis lymphadenopathy may be present on imaging 2
Systemic Complications
Dehydration and Fluid/Electrolyte Disorders
- Volume depletion is a frequently identified risk factor for diarrhea-related deaths in all age groups, particularly affecting young and older adults 4
- Fluid and electrolyte disorders, nontraumatic shock, and acute renal failure are related complications 4
- Elevated creatinine indicating renal involvement can occur 2
Neurological Manifestations
- Stupor and altered mental status can develop as the disease progresses 4
- Hepatosplenomegaly is commonly observed 4
High-Risk Populations
Vulnerable Groups
- Younger patients, particularly children and adolescents, should be closely monitored for complications due to increased risk 5
- Immunocompromised individuals face increased risk of severe disease 5
- Patients with chronic liver disease are at higher risk for hepatic complications 5
- Malnourished children have elevated risk of severe disease progression 5
Clinical Pitfalls and Caveats
Diagnostic Challenges
- Typhoid fever may be difficult to distinguish from other febrile conditions in returned travelers, including malaria, dengue, and brucellosis 4, 6
- Diarrhea is an uncommon feature despite gastrointestinal portal of entry, which can delay diagnosis 4
- The rise of multidrug-resistant and extensively drug-resistant typhoid strains can cause delays in initiating appropriate antibiotics, worsening outcomes 2, 7
Management Considerations
- Blood cultures should be obtained immediately before starting antibiotics to confirm diagnosis 5
- Surgical intervention for perforation should not be delayed, as late diagnosis and difficult transport to facilities contribute significantly to mortality 3
- Appropriate intensive care unit availability is crucial for managing severe complications but often unavailable in peripheral facilities 3