Typhoid and tuberculosis

1. ULCERS OF INTESTINE
INTESTINAL TYPHOID AND
TUBERCULOSIS
DR SRABANI CHAKRABARTI
ASSOCIATE PROFESSOR
DEPT OF PATHOLOGY , CNMC

5. Intestinal Ulcer due to infection
BACTERIAL
 Typhoid ulcer- Salmonella typhi ,paratyphi
 Tuberculosis ulcer - Mycobacterium tuberculosis,bovis
 Pseudomembranous colitis- Clostridium difficile
PROTOZOAL
 amoebic ulcer- Entamoeba histolytica
VIRAL
 CMV colitis cytomegalovirus

6. Topics
TB of intestine
Typhoid of intestine

7. INTESTINAL TUBERCULOSIS
 Tb is a chronic granulomatous disease caused by
MYCOBACTERIUM TUBERCULOSIS mainly.
 It is a common type of extra-pulmonary TB.
 There are three main forms of intestinal tuberculosis -
I primary
 2 secondary
 3 hyperplastic ceacal TB
 Most common abdominal Tb is ILEOCAECAL
TUBERCULOSIS which is ulcerative type in most of the
cases

8. Primary intestinal TB
 MODE OF INFECTION
 In pre- pasturisation era, ingestion of unpasturised
cow’s milk infected with MYCOBACTERIUM BOVIS.
 Due to pasturisation of milk and after eradication of
tuberculosis in cattle nowadays primary intestinal TB
is caused by MYCOBACTERIUM HOMINIS.

9. Primary Intestinal Tb
 In primary TB predominant change is in regional
mesenteric lymph node without any significant
intestinal lesion.
GROSS
 the lymph nodes are enlarged, matted and caseous.
H/P MICROSCOPY
 Tuberculous granuloma with caseation necrosis.

10. SECONDARY TUBERCULOSIS
 Secondary TB occurs in a patient of active
pulmonary TB who swallows the sputum and the
lesion develops in intestine.
 Most common site of intestinal TB is terminal
ileum.
 Hyperplastic caecal TB is a type of secondary TB
where lesion is in caecum and ascending colon
clinically the lesion presents as palpable mass.

11. Secondary tuberculosis
MACROSCOPIC
 Lesions of intestine are prominent than lymph node.
 Large ulcer that is transverse to the long axis of bowel
 serous surface may show visible tubercle.
 Healed lesion may form transverse fibrous stricture
and obstruction.
H/P MICROSCOPY
 mucosa and submucosa show ulceration and typical
granuloma of TB.

13. Gross appearance of TB intestine
tubercle on serosal surface

14. microscopy of TB intestine

15. Typhoid fever
Typhoid fever or enteric fever is an acute systemic
disease caused by S . typhi and S. paratyphi.
MODE OF TRANSMISSION
 Salmonella is ingested through contaminated food or
water
 Finger to mouth contact with faeces, urine or other
secretion.

16. pathogenesis typhoid fever
ingestion via water or food in ileum
penetrates mucosa ,and invades REGIONAL
L. NODE carried via lymphatic and
blood to RE system - multiplies
in G.B discharged in intestine
involves P.PATCH of intestine ,multiplies and
passes to intestine and stool

17. Pathogenesis of typhoid fever

19. Clinical feature & complication
typhoid
CLINICAL FEATURE
 Fever continuous rise in temp step ladder pattern.
 Rose spots on chest and abdomen.
 Spleen is soft and palpable.
 Relative bradycardia.
COMPLICATION
 intestinal perforation & haemorrhage
 encephalopathy, meningitis, myocarditis, cholecystitis.
 CARRIER STATE persistence of S.typhi in gall bladder or
urinary tract.

20. TYPHOID INTESTINE
MACROSCOPY OF INTESTINAL LESION
 most commonly in terminal ileum.
 Peyer’s patches in the terminal ileum enlarges and
shedding of mucosa produces TYPHOID ULCER
which are oval ulcer with their long axis along the
long axis of bowel.
 Base of the ulcer is black due to sloughed mucosa.
 the margins of the ulcer are slightly raised.
 Fibrosis is not significant.

21. Typhoid intestine
MICROSCOPY
 mucosa - oval ulcer over peyer’s patch
 Lamina propria -macrophage containing bacteria RBC
lymphocyte , plasma cell ,neutrophil

23. DIFFERENCE BETWEEN TB AND TYPHOID ULCER
OF INTESTINE
Characteristi
cs
Typhoid ulcer Tubercular ulcer
Site SI involves peyer ’s patch anywhere in the intestine
common in the i-c region
orientation Longitudinal to the long axis as
it involves peyer ’s patch
Transverse to the long axis as
it spreads via lymphatic which
are arranged circumferentially
Microscopy Lymphocyte and plasma cell Granuloma with central area
of necrosis
Perforation Common Not seen
Haemorrhage Common Not seen
stricture uncommon common