paratyphoid fever

Classification

• A, B & C

Etiology

• Salmonella paratyphi

Epidemiology

• transmitted by contaminated food or water
• humans, occasionally, domestic animals are carriers
• Salmonella paratyphi is commonly shed in the stool for 1-2 weeks after recover, but shedding may persist for up to one year
• chronic carriers with Schistosomiasis may shed Salmonella paratyphi in the urine

Clinical manifestations

• sustained fever
• headache
• abdominal pain
• malaise
• anorexia
• non productive cough (early)
• relative bradycardia
• hepatosplenomegaly
• rosy spots on the central body (30% of Caucasians)
• in adults, constipation is more common than diarrhea
• psychosis, confusion, seizures (rare)

Laboratory

• stool culture feces for Salmonella
• urine culture only for suspected chronic carrier
• antibiotic sensitivity

Differential diagnosis

• typhoid fever
  • resembles typhoid fever, but with
    • more abrupt onset
    • milder symptoms
    • shorter course

Management

• emperic therapy with guidance from antibiotic sensitivity
  • fluoroquinolone for 10 days
    • ciprofloxacin
    • levofloxacin
  • ampicillin
  • trimethoprim-sulfamethoxazole
  • ceftriaone or cefotaxime for 14 days
  • aziththromycin for 5 days

Notes

• reportable disease:
  • California code of regulations section 2500

More general terms

• bacterial infection

Additional terms

• Salmonella paratyphi
• typhoid (enteric) fever