Paratyphoid fever , also known simply as paratyphoid , is a bacterial infection caused by one of three types of Salmonella enterica. Symptoms usually begin six to thirty days after exposure and are similar to typhoid fever. Often there is a gradual onset of high fever for several days. Weakness, loss of appetite, and headaches are also common. Some people develop skin rashes with red spots. No symptoms of treatment can last several weeks or months. Others may carry bacteria unaffected; However, still able to spread the disease to others. Both typhoid and paratyphoid have the same severity. Paratyphoid fever is a type of enteric fever along with typhoid fever.
Paratyphoid is caused by bacteria Salmonella enterica from serotype Paratyphi A, Paratyphi B or Paratyphi C that grows in the intestine and blood. They are usually spread by eating or drinking food or water contaminated with feces from an infected person. They may occur when someone who prepares food is infected. Risk factors include poor sanitation as found among the poor. Sometimes they can be transmitted through sex. Humans are the only animals infected. Diagnosis may be based on symptoms and confirmed by culturing bacteria or detecting bacterial DNA in the blood, feces, or bone marrow. Cultivating bacteria can be difficult. The bone marrow test is the most accurate. Symptoms are similar to many other infectious diseases. Typhus is an unrelated disease.
Although there is no special vaccine for paratyphoid, typhoid vaccine may provide some benefits. Prevention includes drinking clean water, better sanitation, and improved handwashing. Treat the disease with antibiotics such as azithromycin. Resistance to a number of other previously effective antibiotics is common.
Paratyphoid affects about 6 million people per year. This is most common in parts of Asia and rare in the developed world. Most cases are caused by Paratyphi A rather than Paratyphi B or C. In 2015 paratyphoid fever produces about 29,200 deaths declining from 63,000 deaths in 1990. The risk of death is between 10% and 15% without temporary treatment with treatment may be less than one percent.
Video Paratyphoid fever
Signs and symptoms
A paratyphoid fever resembles a typhoid fever. Infection is characterized by persistent fever, headache, abdominal pain, malaise, anorexia, nonproductive cough (at an early stage of the disease), relative bradycardia (slow heart rate), and hepatosplenomegaly (enlarged liver and spleen). About 30% of Caucasians develop red spots in the central body. In adults, constipation is more common than diarrhea.
Only 20% to 40% of people initially suffer from abdominal pain. Non-specific symptoms such as chills, sweating, headache, loss of appetite, coughing, weakness, sore throat, dizziness, and muscle aches often appear before the onset of fever. Some very rare symptoms are psychosis (mental disorder), confusion, and seizures.
Maps Paratyphoid fever
Cause
Paratyphoid fever is caused by one of three parathyphoid Salmonella strains: S. Paratyphi A; S. schottmuelleri (also called S. Paratyphi B); or S. hirschfeldii (also called S. Paratyphi C).
Transmission
They are usually spread by eating or drinking food or water contaminated with feces from an infected person. They may occur when someone who prepares food is infected. Risk factors include poor sanitation as found among the poor. Sometimes they can be transmitted through sex. Humans are the only animals infected.
Paratyphoid B
Paratypoid B is more common in Europe. May appear as a disease such as typhoid, as severe gastroenteritis or with both features. Herpes labialis, rarely occurs in actual typhoid fever, is often seen in paratyphoid B. The diagnosis is by isolation of agents in the blood or feces and demonstration of antiBH antibodies in the Widal test. It responds well to chloramphenicol or cotrimoxazole.
Paratyphoid C
Paratyphoid C is a rare infection, commonly seen in the Far East. It appears as septicemia with metastatic abscess. Cholecystitis is possible in the course of the disease. Antibodies against paratyphoid C are usually not tested and the diagnosis is made by blood cultures. Chloramphenicol therapy is generally effective.
Operator
Humans and, sometimes, pets are carriers of paratyphoid fever. The same family member may be a temporary or permanent carrier. In most of the world, short-term fecal carriers are more common than urinary carriers. Chronic carrier status occurs in those with schistosomiasis (parasitic blood coincidence).
It is possible to continue to spill Salmonella Paratyphi up to one year and, during this phase, a person is considered to be a carrier. Chronic carriers may follow acute illness, mild or even subclinical infections. Chronic carriers are most often infected women in middle age.
Pathophysiology
After swallowing if the immune system can not stop the infection, the bacteria will multiply and then spread to the bloodstream, after which the first signs of the disease are observed in the form of fever. Bacteria penetrate deeper into the bone marrow, liver, and bile ducts, from which bacteria are excreted into the intestinal contents. In the second phase of the disease, bacteria penetrate the immune tissue of the small intestine, and the initial symptoms of small bowel movement begin.
Prevention
Providing basic sanitation and safe drinking water and food is the key to disease control. In developed countries, enteric fever levels declined in the past when urban water treatment was introduced, human waste was excluded from food production, and pasteurization of dairy products began. In addition, children and adults should be carefully educated about personal hygiene. This includes careful handwashing after bowel movements and sexual contact, before preparing or eating food, and especially sanitary sewerage. Food handling should be educated in personal hygiene before handling food or equipment and equipment. Infected individuals should be advised to avoid food preparation. People who are sexually active should be educated about the risks of sexual practices that allow fecal-oral contact.
Those traveling to countries with poor sanitation should receive an attenuated live tifoid vaccine - Ty21a (Vivotif), which, in addition to protection against typhoid fever, and may provide protection against paratyphoid fever caused by S. enterica serotypes A and B. In particular, a re-analysis of data from experiments conducted in Chile showed Ty21a vaccine was 49% effective (95% CI: 8-73%) in preventing paratyphoid fever caused by serotype B Evidence from a study of tourists international in Israel also showed the vaccine could prevent a small proportion of infections by serotype A, although no trials confirmed this. This cross-protection with typhoid vaccine is most likely caused by an O antigen divided between the various S. enterica serotypes.
Exclusion from work and social activities should be considered for symptoms, and asymptomatic, persons who are food handlers, health care workers/day care involved in patient care and/or childcare, children attending unhealthy daycare centers , and older children who can not apply good personal hygiene standards. Exceptions apply until two consecutive fecal specimens are taken from an infected patient and reported negatively.
Treatment
Control requires antibiotic treatment and vaccines prescribed by a doctor. The primary control treatments for paratyphoid fever include ciprofloxacin for ten days, ceftriaxone/cefotaxime for 14 days, or aziththromycin.
Prognosis
Those diagnosed with Type A from a bacterial strain rarely die from it except in rare cases of severe bowel complications. With proper testing and diagnosis, the mortality rate drops to less than 1%. Antibiotics such as azithromycin are very effective in treating bacteria.
Epidemiology
Factors outside the home, such as unclean food from street vendors and floods, help to distribute the disease from person to person. Due to poverty and poor hygiene and unhealthy conditions, the disease is more common in less industrialized countries, mainly due to unsafe drinking water problems, inadequate sewerage and flooding. Sometimes causing epidemics, paratyphoid fever is found in most of Asia, Africa, Central and South America. Many of those infected get the disease in Asian countries. About 16 million cases occur a year, resulting in about 25,000 deaths worldwide.
References
Further reading
- "Typhoid and Paratyphoid Fever." Communicable Disease Management Protocol. November 2001 https://www.gov.mb.ca/health/publichealth/cdc/protocol/typhoid.pdf.
- "Typhoid and Paratyphoid Fever." Guidelines for the Management of Verified Public Health Diseases. Disease Control and Prevention. Health and Fitness Alberta: June 2013 https://web.archive.org/web/20130925214850/http://www.health.alberta.ca/documents/Guidelines-Paratyphoid-Fever-2013.pdf
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