Paratyphoid fever is an infectious disease caused by pathogens from the Salmonella enterica group. During the course of the disease, constipation and diarrhea occur. The symptoms are similar to those of typhoid fever, but are not quite as severe.
What is paratyphoid fever?
Paratyphoid fever is a weakened form of the infectious disease typhoid. The causative agent here is Salmonelle paratyphi. The pathogens are distributed worldwide, but infections are more likely to be found in countries with poor hygiene conditions. The disease manifests itself through symptoms such as headache, skin rash, diarrhea, constipation and hair loss. High fever occurs. Some patients become permanent excretors after being infected with paratyphoid.
Causes
The disease is caused by the pathogen Salmonella paratyphi. This belongs to the Salmonella enterica family and may be present in serotypes A, B, and C. The pathogen is a gram-negative bacteria. They are motile and facultatively anaerobic. Salmonella paratyphi is distributed worldwide. Every year, around 5.5 million people in the world contract paratyphoid fever. The highest numbers of cases are in Africa, South America and southern Asia. In 2006, 75 cases of paratyphoid fever were reported to the Robert Koch Institute in Germany. Around 75 percent of the cases were imported from India, Turkey or Serbia. The pathogen reservoir for the salmonellae of the paratyphi type is exclusively humans. In particular, permanent excretors and asymptomatically ill persons play an important role in the spread of the disease. Persistent excretors are people who permanently excrete the pathogen in their stool. In order to obtain the status of persistent excretor, Salmonella must still be detectable in the stool ten weeks after the onset of the disease. Infection with Salmonella paratyphi occurs predominantly through ingestion of contaminated water or contaminated food. Direct transmission from one infected person to another is also conceivable. However, since this must be fecal-oral, this route of transmission is of secondary importance. The incubation period is one to ten days. The risk of infection begins about seven days after the onset of the disease and can persist for several weeks beyond the symptoms. Two to five percent of all ill persons remain symptomless permanent excretors throughout their lives.
Symptoms, complaints, and signs
The disease begins with general discomfort, such as aching limbs, a slight increase in temperature or headache. Within two to three days, the fever rises to as high as 39 degrees Celsius. Those affected feel very ill. There is constipation, diarrhea, vomiting, nausea and abdominal pain. Typical of typhoid and paratyphoid fever are bright red skin appearances on the abdomen. These are also called roseolae. However, they occur rather rarely. In some cases, there is also relative bradycardia. Normally, the pulse increases by ten beats per minute for each degree of temperature increase in fever. In relative bradycardia, this pulse adjustment stops. The temperature is elevated, but the pulse is normal. Complications such as peritonitis, inflammation of the bile ducts, inflammation of the heart or intestinal bleeding can occur. Intestinal perforations or meningitis are also among the conceivable complications. In the case of untreated paratyphoid, the convalescence period is very long. If subefebrile temperatures continue to occur even after symptoms have resolved, this may indicate a recurrence. Recurrences are also possible multiple times. As a rule, however, the disease is over after four to ten days. An infection that is survived leaves an immunity of about one year.
Diagnosis and course of the disease
Paratyphoid infections should be included in the differential diagnosis, especially after travel or time spent abroad. In the laboratory, left shifts in the blood count and leukopenia provide evidence of infection with Salmonella paratyphi. However, only the detection of the pathogen is conclusive. Detection is achieved by cultural cultivation from the blood. However, antibodies against the pathogen can also be detected with the aid of the Widal test. Although this method is very simple and fast, it is not particularly specific or sensitive. Therefore, it is only used in conjunction with a clinically confirmed infection.
Complications
As a result of paratyphoid, affected individuals suffer the discomfort and symptoms of gastroenteritis.These complaints have a very negative impact on the patient’s quality of life and can significantly complicate everyday life. The disease primarily causes diarrhea and constipation. Nausea and vomiting can also occur, and in most cases the affected person also suffers from relatively severe abdominal pain. Furthermore, there is also fever and very severe pain in the extremities and head. If the disease is not treated, it can also lead to inflammation of the internal organs of the affected person. Bleeding in the intestines is also not uncommon. Furthermore, inflammations of the meninges also occur, which without treatment can lead to death in the worst case. After successful treatment, the affected person is immune to the disease for a certain period of time. Treatment is carried out with the help of antibiotics, and no particular complications occur. The patient’s life expectancy is also not affected if treatment is successful. It may be necessary to treat other inflammations caused by paratyphoid fever.
When should you see a doctor?
If high fever, gastrointestinal symptoms, or severe malaise occur, a visit to the doctor is recommended. Paratyphoid fever is also manifested by headache, pain in the limbs, and the characteristic reddish spots on the chest, abdomen, and back. A whitish coating on the tongue is a clear indication of paratyphoid fever and must be examined immediately by a doctor so that any complications can be averted. Anyone who has recently eaten eggs, ice cream and other foods with an increased risk of salmonella should have the above symptoms clarified by a doctor immediately. Contact with stool, urine and other possibly already contaminated substances is also a risk factor that indicates infection with paratyphoid fever or another pathogen and should be clarified by a doctor. Paratyphoid fever is treated by the family doctor or a specialist in internal diseases. Children are first examined by the pediatrician in charge, who may then take direct action or refer the parents to an appropriate specialist. Close consultation with the medical professional should be maintained during treatment.
Treatment and therapy
Therapy for paratyphoid fever always involves antibiotics. In most cases, broad-spectrum antibiotics are used. However, the gyrase inhibitor ciprofloxacin is also used. The duration of therapy is about two weeks. Under antibiotic therapy, the lethality rate is less than one percent. Complications also occur only rarely with this form of therapy. Permanent excretors are also treated with antibiotics. Here, administration over a period of at least one month is recommended. If permanent excretors also suffer from gallstones, removal of the gallbladder may be necessary.
Outlook and prognosis
The typhoid-like paratype can have both a mild and a severe course. The prognosis varies accordingly. In the presence of a severe clinical picture, the paratyphoid patient must be treated with antibiotics. This should be done in a clinic. Only in mild cases can the patient be treated as an outpatient. However, this requires hygienic care. Patients with paratyphoid must be isolated from other people. The prognosis improves with the care with which the caregivers treat the patient. However, the increasingly common antibiotic resistances are problematic. These make successful treatment of paratyphoid more difficult. The risks of treatment failure are higher than in the past. It can take days for treatment to take hold. To improve the chances of curing paratyphoid, antibiotic therapy should last long enough. Paratyphoid recurrences must be ruled out. Complications such as intestinal bleeding and intestinal perforation are common. Such complications occur in affected individuals who cannot be successfully treated or are late to antibiotic therapy. There is a high mortality rate for paratyphoid complications. Emergency surgery may save the lives of some affected individuals. However, postoperative complications are not uncommon. The prognosis is best if paratyphoid is detected early and therapy is started early. This reduces the mortality rate to as low as one percent.
Prevention
Paratyphoid fever is most commonly transmitted through drinking water.In areas where the disease is widespread, tap water should therefore not be drunk. Ice cubes should also be avoided in these countries, as they are often made from tap water. Raw or insufficiently heated food, such as salads or fruit, can also be contaminated with paratyphoid pathogens. The same applies to seafood. A vaccine is also available for typhoid fever. There is no vaccine against paratyphoid fever, however. To protect the environment, persons who have contracted paratyphoid fever must not work in food production. This also applies to permanent parasites. They are prohibited from manufacturing, handling, and marketing certain foods. These foods include sprouts, meat, meat products, milk, milk products, egg products, infant formula, ice cream, baked goods with insufficiently heated fillings, deli salads, raw food salads and mayonnaises. Similarly, people with the disease should not be in community settings such as schools or nurseries.
Aftercare
Aftercare for paratyphoid initially involves strengthening the immune system that has been weakened by the disease. Patients slowly become accustomed to everyday activities again, although intensive sports should be avoided at first. The doctor prescribes when patients may resume physically strenuous activities. A healthy diet supports the regeneration of the body after paratyphoid. The restoration of the intestinal flora is also of particular importance. As a result of paratyphoid fever, the stomach and intestines are sometimes severely impaired and are more susceptible to digestive problems and pathogens for weeks to months after the actual illness. For example, the intake of lactic acid bacteria can help to rebuild the intestinal flora, although the doctor treating the patient should always be consulted. The diet also plays an important role in aftercare. For a few weeks after paratyphoid fever, patients pay particular attention to their food choices and avoid irritating foods, such as overly spicy foods. Much attention should also be paid to the preparation of food to ensure that any germs present are killed off as far as possible. Stomach-friendly meals include well-cooked foods that facilitate digestion and support the regeneration of the stomach and intestines. Suitable and individually tailored recipes are also available from the attending physician or a nutritionist.
What you can do yourself
With persistent diarrhea as well as frequent vomiting, affected persons must pay attention above all to an adequate fluid intake. Still water as well as sugar-free teas are ideal. If necessary, a special glucose-electrolyte mixture from the pharmacy can also be used. Grated apples, bananas and the intake of intestinal cleansing probiotics also provide relief. To mitigate nausea and vomiting, a particularly light diet with several small portions spread throughout the day is recommended. In addition, peppermint and ginger tea can be drunk to combat nausea and loss of appetite. Alcohol and nicotine should initially be avoided completely. Furthermore, sufficient rest should be ensured. For mild headaches, head massages, peppermint oil applied to the temples and fresh air help. If the pain is more severe, painkillers can also be taken after consulting the doctor in charge. They then simultaneously lead to a reduction in the fever that usually also occurs. However, this can also be reduced with cold calf wraps, by wearing light clothing and with elderberry or lime blossom tea. Infectious paratyphoid fever also requires sustained hygiene to prevent infection of third parties. The most important measures here include regular and thorough hand washing, especially after defecation, careful cleaning of used sanitary items, and washing clothing, towels and bed linen as hot as possible.
