Final answer:
In severe cases of Typhoid fever caused by S. typhi, intestinal perforation can occur due to the bacteria penetrating the intestinal mucosa, multiplying within macrophages, and causing ulceration that can develop into perforations in the intestinal wall. If untreated, this can lead to severe outcomes including sepsis and death. Typhoid fever carries a historical significance, famously spread by asymptomatic carriers such as 'Typhoid Mary'.
Step-by-step explanation:
Typhoid fever is a severe infection caused by certain serotypes of S. enterica, primarily serotype Typhi (S. typhi). The disease is characterized by high fever, body aches, headache, nausea, lethargy, and diarrhea or constipation. A lethal complication that may arise in severe cases of typhoid fever is the perforation of the intestine.
S. typhi bacteria penetrate the intestinal mucosa and multiply within the macrophages of the body. As the infection progresses, these macrophages may lyse, releasing the bacteria into the bloodstream and lymphatic system. This can lead to ulceration in the intestine. If the ulceration becomes severe enough, it may eventually cause a perforation—essentially a hole in the intestinal wall. This perforation can result in severe infection, sepsis, and if left untreated, can be fatal due to complications such as severe dehydration or septicemia.
Carriers of S. typhi may be asymptomatic, meaning they show no symptoms but can still spread the bacteria. This is evidenced by the historical case of 'Typhoid Mary,' who inadvertently infected over fifty individuals. Today, with appropriate medical care, the mortality rate for typhoid fever is much lower, but severe complications such as intestinal perforation still pose a significant health risk, particularly in resource-limited settings.