Oxidative stress–driven red blood cell damage underlies anemia in typhoid fever patients

Typhoid fever is a systemic infectious disease associated with considerable morbidity and occasional mortality. Although Salmonella toxins are recognized as key determinants of disease pathology, the contribution of oxidative stress to red blood cell damage and hematological abnormalities in typhoid fever has not been fully elucidated. This study evaluated oxidative stress status and its association with hematological parameters in patients with typhoid fever. Patients with clinical suspicion of typhoid fever were screened using the Typhidot IgM/IgG qualitative enzyme immunoassay. Serum samples from one hundred and two (102) confirmed cases were analyzed for lipid peroxidation using malondialdehyde enzyme immunoassay and for total antioxidant potential using enzyme immunoassay. Full blood count analysis was performed for all participants, and thirty apparently healthy individuals served as controls. Typhoid patients showed significantly reduced mean values of red blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red cell distribution width, and lymphocyte percentage compared with controls (all p < 0.05). In contrast, white blood cell count and granulocyte percentage were significantly elevated (p < 0.05). Circulating free radical levels were markedly higher in typhoid patients than in controls (8.14 ± 1.00 vs 3.31 ± 0.44; p < 0.001), while total antioxidant potential was significantly lower (p < 0.001). Several hematological indices demonstrated strong negative correlations with free radical levels, indicating an association between oxidative stress and red blood cell impairment. These findings suggest that typhoid fever is characterized by a pronounced oxidative imbalance, reflected by increased lipid peroxidation and reduced antioxidant defenses. Beyond the established pathogenic effects of Salmonella toxins, oxidative stress appears to be an important contributory factor to red blood cell damage and hematological disturbances associated with typhoid-related morbidity. Further studies are warranted to clarify the mechanistic role of oxidative injury and to assess the potential benefit of antioxidant-based adjunctive therapeutic strategies in typhoid fever.