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What are the signs and symptoms of typhoid fever and paratyphoid fever?
- Stomach pain
- Diarrhea or constipation
- Loss of appetite
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What are the symptoms of paratyphoid and typhoid fever?
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What are the signs and symptoms of typhoid fever and paratyphoid fever? Weakness Stomach pain Headache Diarrhea or constipation Cough Loss of appetite
Signs and symptoms. Paratyphoid fever resembles typhoid fever. Infection is characterized by a sustained fever, headache, abdominal pain, malaise, anorexia, a nonproductive cough (in early stage of illness), a relative bradycardia (slow heart rate), and hepatosplenomegaly (an enlargement of the liver and spleen).
The most common symptoms of paratyphoid infection include high fever, headaches, weakness, loss of appetite, and diarrhea or constipation. Some people get “rose-colored spots” on the front of the chest during the first week of illness.
In Queensland, several cases of paratyphoid fever are notified each year, most occurring in returned overseas travellers. The symptoms of typhoid fever may be mild or severe and may include prolonged fever, severe headache, malaise, constipation or diarrhoea, rose-coloured spots on the trunk and an enlarged spleen.
- Infectious Agent
- Clinical Presentation
Salmonella entericaserotypes Typhi and Paratyphi A, Paratyphi B, and Paratyphi C cause potentially severe and occasionally life-threatening bacteremic illnesses referred to respectively as typhoid and paratyphoid fever, and collectively as enteric fever. Paratyphi B is differentiated into 2 distinct pathotypes on the basis of their ability to ferment tartrate—one is unable to ferment tartrate and is associated with paratyphoid fever (referred to as Paratyphi B), and the other ferments tartrate and is associated with uncomplicated gastroenteritis (referred to as Paratyphi B var. L(+) tartrate+).
Humans are the only source of these bacteria; no animal or environmental reservoirs have been identified. Typhoid and paratyphoid fever are acquired through consumption of water or food contaminated by feces of an acutely infected or convalescent person or a chronic, asymptomatic carrier. Risk for infection is high in low- and middle-income countries with endemic disease and poor access to safe food, water, and sanitation. Transmission through sexual contact, especially among men who have sex with men, has been documented rarely.
An estimated 26 million cases of typhoid fever and 5 million cases of paratyphoid fever occur worldwide each year, causing 215,000 deaths. In the United States during 2008–2015, approximately 350 culture-confirmed cases of typhoid fever and 90 cases of paratyphoid fever caused by Paratyphi A were reported each year. Cases of paratyphoid fever caused by Paratyphi B and Paratyphi C are rarely reported. Approximately 85% of typhoid fever and 92% of paratyphoid fever cases in the United States occur among international travelers; of those, 80% of typhoid and 91% of paratyphoid fever cases caused by Paratyphi A are acquired by travelers to southern Asia (primarily India, Pakistan, or Bangladesh). Other high-risk regions for typhoid and paratyphoid fever include Africa and Southeast Asia; lower-risk regions include East Asia, South America, and the Caribbean. Travelers visiting friends and relatives are at increased risk, as they may be less careful with food and water while abroad and ma...
The incubation period of typhoid and paratyphoid infections is 6–30 days. The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to as high as 102°F–104°F (38°C–40°C) by the third to fourth day of illness. Fever is commonly lowest in the morning, peaking in the late afternoon or evening. Headache, malaise, and anorexia are nearly universal, and abdominal pain, diarrhea, or constipation are common. Vomiting and diarrhea are more common in children compared with adults. People can also have fatigue, myalgias, dry cough, and sore throat. Hepatosplenomegaly can often be detected. A transient, maculopapular rash of rose-colored spots can occasionally be seen on the trunk. The clinical presentation is often confused with malaria, and typhoid fever should be suspected in a person with a history of travel to an endemic area who is not responding to antimalarial medication. Untreated, the disease can last for a month, and reported...
Patients with typhoid or paratyphoid fever have bacteremia. Blood culture is the mainstay of diagnosis in typhoid and paratyphoid fever; however, a single culture is positive in only approximately 50% of cases. Multiple cultures increase the sensitivity and may be required to make the diagnosis. Bone marrow culture increases the diagnostic yield to approximately 80% of cases and is relatively unaffected by previous or concurrent antibiotic use. Stool culture is not usually positive during the first week of illness, so blood culture is preferred. Urine culture has a lower diagnostic yield than stool culture for acute cases. The Widal test is unreliable but is widely used in developing countries because of its low cost. It measures elevated antibody titers in patients with recent typhoid or paratyphoid fever but may not accurately distinguish acute from past infection and lacks specificity, resulting in false-positive results. Serologic assays are not an adequate substitute for blood,...
Antibiotic therapy shortens the clinical course of enteric fever and reduces the risk for death. Fluoroquinolones (such as ciprofloxacin) are often used for empiric treatment of enteric fever in adults and are considered the treatment of choice for fluoroquinolone-susceptible infections. However, most infections in the United States are acquired during travel abroad, particularly to regions where enteric fever is endemic and fluoroquinolone nonsusceptibility among Typhi and Paratyphi A isolates is common. Fluoroquinolone-nonsusceptible infections are also usually resistant to the synthetic quinolone, nalidixic acid, and have been associated with treatment failure or delayed clinical response. In the United States, ≥90% of Typhi and Paratyphi A infections in travelers to South Asia were found to be fluoroquinolone-nonsusceptible or nalidixic acid–resistant, which suggests that treatment failures may occur among patients treated empirically with fluoroquinolones. Increasingly, azithro...
Food and Water
Safe food and water precautions and frequent handwashing (especially before meals) are important in preventing typhoid and paratyphoid fever (seeChapter 2, Food & Water Precautions). Although vaccines are recommended to prevent typhoid fever, they are not 100% effective, and vaccine-induced immunity can be overwhelmed by a large bacterial inoculum; therefore, even vaccinated travelers should follow recommended food and water precautions. For paratyphoid fever, food and water precautions are t...
The Advisory Committee on Immunization Practices (ACIP) recommends typhoid vaccine for travelers to areas where there is a recognized risk for exposure to Typhi. Destination-specific vaccine recommendations are available at the CDC Travelers’ Health website (www.cdc.gov/travel). Two unconjugated typhoid vaccines are licensed and available in the United States: 1. Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for intramuscular use 2. Oral live attenuate...
and paratyphoid fever affect an estimated 11–21 million people worldwide each year. These diseases are rare in the United States, but they are common in many countries. Some people also have a cough or rash. Internal bleeding and death can occur but are rare. High fever Weakness Headache Loss of appetite Diarrhea or constipation Stomach pain. Symptoms
- Risk Factors
- Incubation Period
- Presentation of Typhoid Fever
- Symptoms of Paratyphoid Fever
- Differential Diagnosis
- Antibiotic Treatment of Typhoid Fever
Typhoid and paratyphoid fevers are caused by related but different strains of Salmonella spp. There is considerable overlap in symptoms, although typhoid is the more severe and long-lasting disease, and is the one more likely to result in death if prompt treatment is not given. The name typhoid means 'resembling typhus', and was chosen because of the occurrence of neuropsychiatric symptoms in all three diseases. However, although there can be some symptom overlap, typhus, and the related condition scrub typhus, are completely separate diseases.
Apart from exposure to the organism, a number of host factors increase the risk of infection with Salmonellaspp. by reducing the necessary infectious organism load. These include: 1. Disease-related or iatrogenic achlorhydria (antacids, H2-receptor antagonists, proton pump inhibitors), reduction in stomach acidity or gut pathology (surgery, inflammatory bowel disease, malignancy) and recent antibiotics increase the susceptibility to infection. 2. Immunosuppression of any cause. 3. Several other infections, notably schistosomiasis, malaria, histoplasmosis and bartonellosis, are associated with an increased risk of infection with Salmonellaspp. 4. Typhoid is more common, and more severe at the extremes of age. Neonatal typhoid, usually acquired from the mother, may follow a fulminant course often with meningitis. 5. Patients with haemoglobinopathies, particularly sickle cell disease, are also at increased risk.
This depends on the infecting dose ingested - it is typically 10-20 days for S. typhi(but may be as short as three days). During this phase, 10-20% of patients have transient diarrhoea. The incubation period for paratyphoid has previously been reported to be shorter (1-10 days). However, the surveillance data for England, Wales and Northern Ireland 2007-2010 did not show any significant differences between typhoid and paratyphoid in time of onset of symptoms on arrival to the UK. 1. 98% of cases had an onset date within 35 days of return from travel. 2. 91% had an onset date within 21 days.
Typhoid is one of the most common febrile illnesses seen by practitioners in the developing world. Untreated, the illness usually lasts for three to four weeks, but may be longer. Symptoms vary from mild to severe and life-threatening. The course of untreated typhoid fever is classically divided into four stages, each lasting about a week. This disease pattern is not commonly seen, with severe disease representing the 'tip of the iceberg' in typhoid, and with the advent of antibiotics altering the course of the disease. For descriptions of the untreated disease the literature relies on historical descriptive accounts by physicians such as Sir William Osler.Vague chills, sweating, headache, weakness, dry cough, anorexia, sore throat, dizziness, and muscle pains are frequently present before the onset of fever.Rising then persistent fever.Abdominal pain (in about a third of patients).Relative bradycardia.
The group of symptoms which most clearly suggests the diagnosis of typhoid fever is: 1. Gradually increasing fever with evening exacerbation and morning remission. 2. General malaise with headache. 3. Furred tongue with red edges and tip. 4. Epistaxis. 5. Relatively slow pulse (possibly dicrotic). 6. Abdominal distension with increased bowel sounds. 7. Tenderness in the right iliac fossa on firm pressure. 8. A roseolar eruption confined principally to the abdomen and chest. 9. Splenomegaly. 10. Bronchial catarrh. The differential diagnosis of this group of symptoms will depend on travel history and may include a wide variety of tropical and non-tropical causes of fever and rash. Always consider co-existent malaria or schistosomiasis. In patients with appropriate travel history malaria remains the most likely cause of febrile illness, although this does not rule out the presence of additional disease. A list of diagnoses to consider in the returning traveller with febrile illness, ab...
1. Diagnosis is made by culturing the organism. This may be obtained from stool or other sources. 2. Blood cultures are only positive in 40-60% of cases. However, this may be enhanced to above 80% using two sets of blood cultures and modern methods. 3. The most sensitive source (90% isolation rate) is bone marrow aspiration. 4. Isolation of S. typhiis highest in the first week and becomes more difficult as time passes.
1. The traditional serological test is Widal's test. It measures agglutinating antibodies against flagellar (H) and somatic (O) antigens of S. typhi. 2. High or rising O antibody titres generally indicate acute infection, whereas H antibody is used to identify the type of infection. 3. The test is positive on admission in between 40-60% of patients but the test has enormous variation between laboratories in terms of sensitivity, specificity and predictive value. 4. The validity of rapid diagn...
In non-endemic countries, patients presenting with symptoms suggestive of typhoid or paratyphoid fever are initially assessed in hospital where a firm diagnosis by blood culture or bone marrow culture can be made, and antibiotic sensitivities determined. Empiric antibiotic treatment is commenced depending on the likely source of the infection (country travelled to). Clinically unstable patients are admitted to hospital for IV treatment while those who are stable may be treated as outpatients. General principles for the management of typhoid[3, 4]: 1. Rapid diagnosisand institution of appropriate antibiotic treatment. 2. Adequate nutrition- a soft, easily digestible diet should be continued unless the patient has abdominal distension or ileus 3. Supportive- adequate rest, rehydration and correction of electrolyte disturbances. 4. Antipyretic therapy- as required. 5. Hygiene- carers must be meticulous with hand washing and the disposal of faeces and urine. 6. Close attention to hand w...Ideal antibiotic treatment is safe and available in short courses of five days, causes resolution of fever within one week, renders blood and stool cultures sterile, and prevents relapse.Azithromycin has been found to meet these criteria better than other drugs, although localised areas of resistance to azithromycin have been reported.Ciprofloxacin was the drug of choice for ten years following the emergence of resistance to chloramphenicol, ampicillin, and trimethoprim (multidrug-resistant typhoid). However, over 80% of S. typh...Among fluoroquinolones, which are more effective than cephalosporins, gatifloxacin appears more effective than ciprofloxacin and ofloxacin for bacteria showing decreased ciprofloxacin sensitivity.The two most common complications are haemorrhage (including disseminated intravascular coagulation) and perforation of the bowel. Before antibiotics, perforation had a mortality of around 75%.Jaundice may be due to hepatitis, cholangitis, cholecystitis, or haemolysis.Pancreatitis with acute kidney injury and hepatitis with hepatomegaly are rare.Toxic myocarditis occurs in 1-5% of patients (ECG changes may be present). It is a significant cause of death in endemic areas.
If, besides all the above, the pulse and breathing increase, there is a chance that the animal is infected with paratyphoid fever. But you shouldn’t do something against him right away, for the beginning it is necessary to pass tests, the results of which will confirm or refute the diagnosis.