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      • If you are being treated for typhoid fever or paratyphoid fever, it is important to do the following to lower the chance that you will pass the bacteria on to someone else. Keep taking antibiotics for as long as the doctor has recommended. Wash your hands carefully with soap and water after using the bathroom.
      www.cdc.gov/typhoid-fever/symptoms.html
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  2. If you are being treated for typhoid fever or paratyphoid fever, it is important to do the following to lower the chance that you will pass the bacteria on to someone else. Keep taking antibiotics for as long as the doctor has recommended. Wash your hands carefully with soap and water after using the bathroom.

  3. you feel very ill, especially if you have a fever. • Tell them when and where you traveled. • They may conduct tests that can diagnose infection. • Avoid contact with other people while you are sick. • Do not prepare or serve food to other people. • Typhoid and paratyphoid fever are treated with antibiotics. • Take them for as long as

    • Infectious Agent
    • Transmission
    • Epidemiology
    • Clinical Presentation
    • Diagnosis
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    • Prevention

    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...

    Vaccine

    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...

  4. What is the treatment for paratyphoid infection? Antibiotics and supportive care are used to treat paratyphoid infection. If your healthcare provider prescribes antibiotics, it is important that you take the medicine exactly as instructed.

  5. Prevention. Typhoid and paratyphoid fever can be prevented by the provision of safe water, safe sewage disposal and good food hygiene. Chronic typhoid carriers pose a special risk to the community, so programs to detect and treat chronic carriers need to be in place.11.

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