Complications of Typhoid Fever: From Most Common to Least Common
Most Common Complications
The most common complications of typhoid fever are wound infections, wound dehiscence, and intra-abdominal abscesses, occurring in approximately 49% of patients who develop intestinal perforation, which itself is the most frequent severe complication. 1, 2
1. Intestinal Perforation (Most Common Severe Complication)
- Ileal perforation is the most frequent life-threatening complication, typically occurring in the terminal ileum during the third week of untreated disease 1, 3
- Solitary cecal perforation accounts for approximately 45.8% of perforation cases in children 4
- Presents with abdominal pain and peritonitis in patients with prolonged febrile illness (2-6 weeks) 2, 5
- Carries mortality rates of 15-60% depending on timing of intervention and resource availability 1, 2, 5, 6
2. Post-Operative Wound Complications (Most Common After Surgery)
- Wound infection is the single most common complication, occurring in the majority of the 49.1% who develop post-operative morbidity 1, 2
- Wound dehiscence follows as the second most common wound-related complication 1, 2
- Burst abdomen represents a severe form of wound dehiscence and significantly increases mortality 1, 2, 5
3. Intra-Abdominal Abscesses
- Residual intra-abdominal abscesses are among the most common post-operative complications 1, 2, 6
- Occur more frequently with delayed presentation and severe peritoneal contamination 1, 5
4. Enterocutaneous Fistulae
Moderately Common Complications
5. Gastrointestinal Bleeding
- Documented as a recognized complication of typhoid fever 3
- Less common than perforation but clinically significant
6. Anemia
- One of the two most common problems prolonging hospital stay 4
- Can result from both the disease process and gastrointestinal bleeding
7. Septic Shock
- Occurs with severe peritoneal contamination and delayed presentation 2, 3, 5
- Manifests with hypotension (systolic BP <90 mmHg), tissue hypoperfusion, decreased capillary refill, skin mottling, and peripheral cyanosis 2, 5
Less Common Complications
8. Encephalopathy
- Rare but serious neurological complication 3
- Requires urgent recognition and treatment
9. Rhabdomyolysis
- Rare complication documented in case reports 7
- Can present with severe muscle breakdown and renal complications
10. Hemophagocytic Lymphohistiocytosis (HLH)
- Extremely rare complication presenting with fever, severe pancytopenia, and multi-organ involvement 7
- Represents one of the least common but most severe complications
Critical Prognostic Factors
Multiple perforations, severe peritoneal contamination, delayed presentation beyond 24 hours, and burst abdomen are the key factors that dramatically worsen outcomes and increase complication rates. 1, 2, 5
- Mortality ranges from 4.6% to 75% across different settings, with most studies reporting 11-30% 6
- Optimal management with early intervention can achieve mortality rates of 15-19%, while delayed care in resource-limited settings approaches 60% 1, 2, 5, 6
- Aggressive fluid resuscitation (>10 ml/kg intraoperatively) and broad-spectrum antibiotics significantly reduce both early and late mortality 8