Typhoid Fever and Coated Tongue: Pathophysiology and Management

Salmonella Typhi causes systemic infection; coated tongue is a classic but nonspecific sign.

Mechanism of Tongue Coating

• Bacterial toxins (endotoxin, Vi antigen) → local inflammation, epithelial desquamation, fibrinous exudate.
• Dehydration from fever, reduced intake → xerostomia, reduced clearance.
• Poor oral hygiene due to malaise → bacterial/fungal overgrowth on retained debris.
• Immune dysregulation alters oral microbiome.

Clinical Features

White-yellow fur, especially posterior dorsum; may have "rose spots" (trunk macules), relative bradycardia, hepatosplenomegaly.

Diagnosis

Blood culture (gold standard, 40–80% sensitive), stool/urine culture, Widal test (limited specificity), PCR.

Treatment

• Antibiotics: Ceftriaxone, azithromycin, fluoroquinolones (resistance-guided).
• Supportive: hydration, antipyretics, nutrition.

Resolution

Coating clears with defervescence and rehydration. Persistent coating → evaluate for oral candidiasis, leukoplakia, or lingering bacteremia.