TYPHOID AND

PARATYPHOID FEVER
PROGRESSION OF ILLNESS
Week 1 Week 2 Week 3

Persistent fever , but no chills;

Body temperature rises gradually Clinical features of week 2
mostly unresponsive to antipyretics

Additional possible complications

Relative bradycardia Nonspecific abdominal pain and headaches include:

Constipation or diarrhea Rose-colored spots Intestinal bleeding and perforation

Typhoid tongue: greyish/yellowish-coated

Headache Hepatosplenomegaly
tongue with red edges

Rarely causes sepsis, meningitis,

Yellow-green diarrhea
myocarditis, and renal failure

Neurological symptoms (delirium, coma)

Rose-colored
spots: in 30%
of patients, a
small, speckled,
and 
rose-colored 
exanthem
 appears on the
lower chest and
abdomen (most
commonly
around the navel
)
DIAGNOSTICS
Laboratory tests
• Anemia
• Leukopenia or leukocytosis  
• Abnormal liver function tests

Pathogen detection
• Blood cultures: Bacteremia is detectable starting in week 1 of the disease. 
• Stool cultures 
• Serology (Widal test) 
Blood culture is the most important diagnostic tool at disease onset, as are often
negative despite active infection
TREATMENT

First line treatment: fluoroquinolone antibiotics (e.g., ciprofloxacin)

Azithromycin, if resistance to fluoroquinolone antibiotics is suspected

(e.g., in patients with infection acquired from certain regions, such as South
Asia)

Third-generation cephalosporins (e.g., ceftriaxone) are preferred for severe infection.

COMPLICATIO Chronic Salmonella carrier
NS

Definition: positive stool cultures 12 months after overcoming the disease

Incidence: up to 6% of the patients become chronic carriers

Presentation: typically asymptomatic 

Increased risk for gallbladder cancer

Treatment: fluoroquinolones (e.g., ciprofloxacin) administered for at least 1 month

Chronic carriers are not allowed to work in the food industry.

PREVENTION
Food and water
Vaccination is not entirely
effective. Measure must
therefore be implemented
to avoid exposure
Vaccination
Indication: The WHO
Administration: A
recommends typhoid
parenteral, inactivated
fever vaccination to those
vaccine and an oral, live
traveling to high-risk areas
vaccine are available
for active immunization,
(East and Southeast Asia,
and both provide similar
South and Central
levels of protection. 
America, Africa).
SUMMARY
Typhoid and paratyphoid fever caused by the bacteria Salmonella typhi and Salmonella paratyphi.
• Transmission : fecal-oral route.
• Incubation period : 7–21 days

Have three clinical stages.

• In the first week ➠ body temperature rises gradually and relative bradycardia as well as
diarrhea or constipation.
• The second week, ➠ persistent fever, rose-colored spots on the abdomen, nonspecific
abdominal pain and profuse diarrhea.
• The third week ➠ complications (hepatosplenomegaly, intestinal bleeding, and/or perforation
with secondary bacteremia and peritonitis)

Symptoms begin to subside in the fourth week.

Pathogen detection in blood and stool cultures confirms the diagnosis.

The treatment of choice includes fluoroquinolone antibiotics such as ciprofloxacin.

Up to 6% of patients become chronic carriers after symptoms have resolved.

FINISH