Paratyphoid fever

Paratyphoid fever
Rose colored spots on the chest of a person with typhoid fever which are similar to those of paratyphoid
Classification and external resources
Specialty Infectious disease
ICD-10 A01.1-A01.4
ICD-9-CM 002
DiseasesDB 33218
Patient UK Paratyphoid fever
MeSH D010284

Paratyphoid fever, also known simply as paratyphoid, is a bacterial infection caused by one of the three types of Salmonella enterica.[1] Symptoms usually begin six to thirty days after exposure and are the same as those of typhoid fever.[1][2] Often there is a gradual onset of a high fever over several days. Weakness, loss of appetite, and headaches also commonly occur.[1] Some people develop a skin rash with rose colored spots.[3] Without treatment symptoms may last weeks or months.[1] Other people may carry the bacteria without being affected; however, are still able to spread the disease to others.[2] Both typhoid and paratyphoid are of similar severity.[2] Paratyphoid fever is a type of enteric fever along with typhoid fever.[4]

Paratyphoid is caused by the bacteria Salmonella enterica of the serotype Paratyphi A, Paratyphi B or Paratyphi C growing in the intestines and blood. They are usually spread by eating or drinking food or water contaminated with the feces of an infected person.[1] They may occur when a person who prepares food is infected.[3] Risk factors include poor sanitation as is found among poor crowded populations.[5] Occasionally they may be transmitted by sex. Humans are the only animal infected.[1] Diagnosis maybe based on symptoms and confirmed by either culturing the bacteria or detecting the bacteria's DNA in the blood, stool, or bone marrow.[1][2] Culturing the bacteria can be difficult.[2] Bone marrow testing is the most accurate.[5] Symptoms are similar to that of many other infectious diseases.[2] Typhus is an unrelated disease.[6]

While there is no vaccine specifically for paratyphoid, the typhoid vaccine may provide some benefit.[1][3] Prevention includes drinking clean water, better sanitation, and better handwashing. Treatment of disease is with antibiotics such as azithromycin. Resistance to a number of other previously effective antibiotics is common.[1]

Paratyphoid affects about 6 million people a year.[1][7] It is most common in parts of Asia and rare in the developed world.[1][3] Most cases are due to Paratyphi A rather than Paratyphi B or C.[2] In 2013 paratyphoid fever resulted in about 54,000 deaths down from 63,000 deaths in 1990.[8] The risk of death is between 10% and 15% without treatment while with treatment it may be less than one percent.[2]

Signs and symptoms

Rose spots on abdomen of a person with typhoid fever

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). About 30% of Caucasians develop rosy spots on the central body. In adults, constipation is more common than diarrhea.

Only 20% to 40% of people initially have abdominal pain. Nonspecific symptoms such as chills, sweating, headache, loss of appetite, cough, weakness, sore throat, dizziness, and muscle pains are frequently present before the onset of fever. Some very rare symptoms are psychosis (mental disorder), confusion, and seizures.

Cause

Paratyphoid fever is caused by any of three strains of Salmonella paratyphoid: 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 the feces of an infected person.[1] They may occur when a person who prepares food is infected.[3] Risk factors include poor sanitation as is found among poor crowded populations.[5] Occasionally they may be transmitted by sex. Humans are the only animal infected.[1]

Paratyphoid B

Paratyphoid B is more frequent in Europe. It can present as a typhoid-like illness, as a severe gastroenteritis or with features of both. Herpes labialis, rare in true typhoid fever, is frequently seen in paratyphoid B. Diagnosis is with isolation of the agent in blood or stool and demonstration of antibodies antiBH in the Widal test. The disease responds well to chloramphenicol or co-trimoxazole.

Paratyphoid C

Paratyphoid C is a rare infection, generally seen in the Far East. It presents as a septicaemia with metastatic abscesses. Cholecystitis is possible in the course of the disease. Antibodies to paratyphoid C are not usually tested and the diagnosis is made with blood cultures. Chloramphenicol therapy is generally effective.

Carriers

Humans and, occasionally, domestic animals are the carriers of paratyphoid fever. Members of the same family can be transient or permanent carriers. In most parts of the world, short-term fecal carriers are more common than urinary carriers. The chronic urinary carrier state occurs in those who have schistosomiasis (parasitic blood fluke).

It is possible to continue to shed Salmonella Paratyphi for up to one year and, during this phase, a person is considered to be a carrier. The chronic carrier state may follow acute illness, mild or even subclinical infections. Chronic carriers are most often women who were infected in their middle age.

Pathophysiology

After ingestion if the immune system is unable to stop the infection, the bacterium will multiply and then spread to the bloodstream, after which the first signs of disease are observed in the form of fever. The bacterium penetrates further to the bone marrow, liver, and bile ducts, from which bacteria are excreted into the bowel contents. In the second phase of the disease, the bacterium penetrates the immune tissue of the small intestine, and the initial symptoms of small-bowel movements begin.

Prevention

Providing basic sanitation and safe drinking water and food is the key for controlling the disease. In developed countries, enteric fever rates decreased in the past when treatment of municipal water was introduced, human faces were excluded from food production, and pasteurization of dairy products began.[5] In addition, children and adults should be carefully educated about personal hygiene. This would include careful handwashing after defecation and sexual contact, before preparing or eating food, and especially the sanitary disposal of feces. Food handlers should be educated in personal hygiene prior to handling food or utensils and equipment. Infected individuals should be advised to avoid food preparation. Sexually active people should be educated about the risks of sexual practices that permit fecal-oral contact.[9]

Those who travel to countries with poor sanitation should receive a live attenuated typhoid vaccine—Ty21a (Vivotif), which, in addition to the protection against typhoid fever, and may provide some protection against paratyphoid fever caused by the S. enterica serotypes A and B.[5] In particular, a reanalysis of data from a trial conducted in Chile showed the Ty21a vaccine was 49% effective (95% CI: 8–73%) in preventing paratyphoid fever caused by the serotype B.[10] Evidence from a study of international travelers in Israel also indicates the vaccine may prevent a fraction of infections by the serotype A, although no trial confirms this.[11] This cross-protection by a typhoid vaccine is most likely due to O antigens shared between different S. enterica serotypes.[11]

Exclusion from work and social activities should be considered for symptomatic, and asymptomatic, people who are food handlers, healthcare/daycare staff who are involved in patient care and/or child care, children attending unsanitary daycare centers, and older children who are unable to implement good standards of personal hygiene. The exclusion applies until two consecutive stool specimens are taken from the infected patient and are reported negative.

Treatments

Control requires treatment of antibiotics and vaccines prescribed by a doctor. Major control treatments for paratyphoid fever include ciprofloxacin for ten days, ceftriaxone/cefotaxime for 14 days, or aziththromycin.

Prognosis

Those diagnosed with Type A of the bacterial strain rarely die from it save in rare cases of severe intestinal complications. With proper testing and diagnosis, the mortality rate falls to less than 1%. Antibiotics such as azithromycin are particularly effective in treating the bacteria.[12]

Epidemiology

Factors outside the household, such as unclean food from street vendors and flooding, help distribute the disease from person to person.[9] Because of poverty and poor hygiene and sanitary conditions, the disease is more common in less-industrialized countries, principally owing to the problem of unsafe drinking water, inadequate sewage disposal, and flooding.[13] Occasionally causing epidemics, paratyphoid fever is found in large parts of Asia, Africa, Central and South America. Many of those infected get the disease in Asian countries. About 16 million cases occur a year, which result in about 25,000 deaths worldwide.[14]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 Anna E. Newton (2014). "3 Infectious Diseases Related To Travel". CDC health information for international travel 2014 : the yellow book. ISBN 9780199948499.
  2. 1 2 3 4 5 6 7 8 Alan J. Magill (2013). Hunter's tropical medicine and emerging infectious diseases (9th ed.). London: Saunders/Elsevier. pp. 568–572. ISBN 9781455740437.
  3. 1 2 3 4 5 Jeremy Hawker (2012). "3.56". Communicable disease control and health protection handbook (3rd ed.). Chichester, West Sussex, UK: Wiley-Blackwell. ISBN 9781444346947.
  4. ↑ Wain, J; Hendriksen, RS; Mikoleit, ML; Keddy, KH; Ochiai, RL (21 March 2015). "Typhoid fever.". Lancet. 385 (9973): 1136–45. doi:10.1016/s0140-6736(13)62708-7. PMID 25458731.
  5. 1 2 3 4 5 Crump, JA; Mintz, ED (15 January 2010). "Global trends in typhoid and paratyphoid Fever.". Clinical Infectious Diseases. 50 (2): 241–6. doi:10.1086/649541. PMID 20014951.
  6. ↑ Cunha BA (March 2004). "Osler on typhoid fever: differentiating typhoid from typhus and malaria". Infect. Dis. Clin. North Am. 18 (1): 111–25. doi:10.1016/S0891-5520(03)00094-1. PMID 15081508.
  7. ↑ Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet (London, England). 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMID 26063472.
  8. ↑ GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604Freely accessible. PMID 25530442.
  9. 1 2 Bhan MK, Bahl R, Bhatnagar S (2005). "Typhoid and paratyphoid fever". Lancet. 366 (9487): 749–62. doi:10.1016/S0140-6736(05)67181-4. PMID 16125594.
  10. ↑ Levine, M. M.; Ferreccio, C.; Black, R. E.; Lagos, R.; Martin, O. S.; Blackwelder, W. C. (2007). "Ty21a Live Oral Typhoid Vaccine and Prevention of Paratyphoid Fever Caused by Salmonella enterica Serovar Paratyphi B". Clinical Infectious Diseases. 45: S24. doi:10.1086/518141. PMID 17582564.
  11. 1 2 Whitaker, J. A.; Franco-Paredes, C.; Del Rio, C.; Edupuganti, S. (2009). "Rethinking Typhoid Fever Vaccines: Implications for Travelers and People Living in Highly Endemic Areas". Journal of Travel Medicine. 16 (1): 46–52. doi:10.1111/j.1708-8305.2008.00273.x. PMID 19192128.
  12. ↑ "Medical Conditions and Medical Information: ADAM Medical Library of Health Condi". Healthatoz.com. Retrieved 2011-10-06.
  13. ↑ "Water-related Diseases." Communicable Diseases 2001. World Health Organization. 31 Oct 2008 <http://www.who.int/water_sanitation_health/diseases/typhoid/en/>.
  14. ↑ Rubin, Raphael., David S. Strayer., Emanuel Rubin., Jay M. McDonald. Rubin's Pathology. 5th ed. 2007

Further reading

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