Enteric fever (typhoid and

paratyphoid
 Enteric fever (typhoid and
paratyphoid)
• Definition • Aetiology/pathophysiol
• Typhoid (Salmonella ogy
typhi) and paratyphoid • Humans are the only
(Salmonella reservoir. Transmission
• paratyphi A, B or C) is by the
produce a clinically • faeco–oral route or via
identical disease. contaminated food and
water.
• The incubation period is
10–14 days.
• Organisms pass via the • Some secrete
ileum and the lymphatic salmonella for over a
system to the systemic year and measurement
circulation causing a of Vi agglutinin is used
bacteraemia. to detect carrier states
• Gut re-invasion leads to
the clinical picture.
• Clinical features
• 1 The condition typically
runs a course of around • 2 Week 2 the patient
1 month. Week 1 results
from the bacteraemia.
• There is gradual onset
of a viral like illness with
headache and fever
worsening over 3–4
days.
• There is initially
constipation.
appears toxic with
dehydration, constant
fever, abdominal
painanddiarrhoea.Patients
develop an erythematous
maculopapular-blanching
rash with splenomegaly
• 3 During week 3 • 4 Over the subsequent
complications include week there is a gradual
pneumonia, haemolytic return to normal health
anaemia, meningitis,
peripheral neuropathy,
acute cholecystitis,
osteomyelitis, intestinal
perforation and
haemorrhage.
• Investigations
• Blood cultures are positive
in 80% in week one and in
30% by week three.
• Stool cultures are more
helpful in the second to
fourth weeks.
• Serological testing is by the
Widal test measuring
serum agglutinins against O
and H antigens
• Management
• Ciprofloxacin,
chloramphenicol and
amoxycillin have all been
used.
• Supportive management
includes fluid and
electrolyte balance and
management of
complications.
• Carrier state eradication is
by 4 weeks of
ciprofloxacin and if
unsuccessful
cholecystectomy can be
tried, as the gallbladder is
often the site of infection.
• A vaccine is available
which gives some
protection for up to 3
years.