Paratyphoid Fever - Cause, Complications, Diagnosis, and Treatment

Introduction:

Paratyphoid is a bacterial infection caused by Salmonella enterica serotypes, which grows in the intestine and blood. It affects almost six million people every year. Paratyphi A type is more common than Paratyphi B and C. The number of deaths has significantly reduced from 1990 to 2015 from 63000 to 29000 deaths, respectively. However, the reason for death is improper or no treatment. Following preventive strategies may help fight against the disease.

What Are the Signs and Symptoms of Paratyphoid Fever?

Symptoms of paratyphoid fever usually appear after 6 to 30 days of exposure. The common symptoms of paratyphoid fever are

• Fever.

• Headache.

• Anorexia (eating disorder).

• Cough.

• Fatigue (weakness).

• Sweating.

• Bradycardia (slow heart rate).

• Hepatomegaly (enlargement of the liver).

• Splenomegaly (enlargement of the spleen).

• Rose spots on central body parts.

• Modification in bowel habits, such as constipation or diarrhea.

• Weight loss.

• Abdominal pain.

• Loss of appetite.

• Sore throat.

• Dizziness.

• Muscle pain.

• Psychosis (mental issues).

• Seizures.

• Confusion.

• Herpes labialis (herpes infection along the lip borders).

• Gastroenteritis (intestinal infection).

• Septicemia (infection in the bloodstream).

If the condition is left untreated, the symptoms may last for weeks to months. In some cases, individuals may act as carriers without any symptoms but transmit the disease to others.

What Are the Causes of Paratyphoid Fever?

Paratyphoid fever is caused by Paratyphi A, B, and C, the serotypes of Salmonella enterica. Humans are the only affected species, where the transmission occurs commonly by consuming food and water contaminated with infected individuals’ feces. In addition, it can spread through food prepared by the infected person. The bacteria can spread quickly among populations with poor access to clean food, water, and sanitation. However, rare transmission by sex is noted.

What Is the Pathophysiology of Paratyphoid Fever?

If the infectious agent gets ingested by an individual and if the immune system cannot fight against it, the bacteria multiply and get distributed to the bloodstream. This process causes the first sign of paratyphoid, which is fever. Then, the bacteria enter the bone marrow, bile ducts, and liver and get released into the bowel contents. After that, it penetrates the small intestine’s immune tissues and initiates bowel movement symptoms.

What Are the Complications of Paratyphoid Fever?

• Intestinal bleeding with a sudden decline in blood pressure and bloody feces.

• Intestinal perforation leaks the intestinal contents and blood into the abdominal cavity.

• Meningitis (inflammation of the brain covering membranes).

• Lung infections such as pneumonia.

• Kidney infection.

• Urinary bladder infection.

How Is Paratyphoid Fever Diagnosed?

The diagnosis of paratyphoid fever can be made by performing the following investigations.

• Clinical symptoms and history.

• Blood tests reveal leucopenia (reduced leucocyte count) and thrombocytopenia (reduced platelet count).

• Bacterial culture.

• Detection of bacterial DNA (deoxyribonucleic acid) in the stool or blood.

• Bone marrow culture can identify bacterial genetic material.

• Serological assays like agglutination and ELISA (enzyme-linked immunosorbent assay).

• The Widal test identifies the antibodies in the blood or stool.

• A urine culture can be done but has low diagnostic significance.

How Is a Paratyphoid Fever Treated?

Paratyphoid fever can be treated with antibiotics and vaccines. The most commonly prescribed drugs are Ciprofloxacin, Azithromycin, or Cefotaxime. In addition, Chloramphenicol and Clotrimazole are prescribed for patients affected by Paratyphi B and C serotypes. The antibiotic coverage can be continued for at least three to five days; however, the temperature gradually decreases daily. If the fever persists even after five days of taking the antibiotics, alternative drugs can be prescribed, or any foci of infection must be identified. The common foci of infection are abscesses (a pus-filled cavity), joint or bone infections, and extraintestinal site infections. Additional antibiotic treatment might be required for patients with chronic fever, relapse, or reinfection. In some cases, the patients treated might become asymptomatic but act as carriers, so the antibiotic coverage has to be continued for prolonged periods.

Patients with severe complications of paratyphoid fever must be hospitalized for proper medical care and management.

How Can Paratyphoid Fever Be Prevented?

The preventive measures to be followed are

• No vaccine is available for paratyphoid; however, the typhoid vaccine is effective. They can be administered.

• Consume safe drinking water and food.

• Children must be educated about hygienic practices.

• Proper disposal of feces.

• Avoiding sexual acts with an infected person.

• Avoid traveling to areas with poor sanitation.

• Avoid buying food from the streets.

• Avoid eating food served at a cold temperature.

• Avoid eating seafood.

• Avoid eating raw fruits and vegetables. Instead, cook or eat peeled ones.

• Avoid consumption of unpasteurized milk or dairy products.

• Avoid using unclean municipal water for drinking and cooking. Instead, use filtered and purified water.

How Can a Carrier Avoid Infecting Others?

The carriers are asymptomatic but carry the bacteria and transmit it to others. Therefore, the following have to be followed to avoid infecting others.

• Take a break from school or work.

• Avoid traveling.

• Avoid handling or preparing food for others.

• Avoid sharing food utensils and towels with others.

• Wash hands with soap and water.

• Avoid sexual activity.

What Is the Prognosis of Paratyphoid Fever?

Paratyphoid fever caused by Paratyphi A has less mortality, which is less than 1 percent, except in certain rare cases with severe intestinal problems. However, proper testing, early detection, diagnosis, and treatments improve their prognosis; especially, azithromycin is effective in treating paratyphoid fever.

Conclusion:

Paratyphoid fever is an infectious disease that can spread from human to human quickly. The mortality rate of the disease has reduced in recent years due to proper sanitary practices of people. Most individuals, unaware of the spread of contagious disease, travel often and unknowingly come in contact with an infected person. More campaigns should be held to make people aware of infectious diseases.