Paratyphoid
fever diagnosis
Pathogen
review :
salmonella enterica serotypes Typhi and
Paratyphi A,
Paratyphi B (tartrate negative), and Paratyphi
C cause a potentially severe and occasionally life-threatening bacteremic
illness referred to respectively as typhoid and paratyphoid fever, and
collectively as ((enteric fever))
DIAGNOSIS:
First is to review in mind
the Clinical presentation
The incubation period
of typhoid and paratyphoid infections is 6–30 days.The onset of illness is
insidious with gradually increasing fatigue and a fever that increases daily
from low-grade to as high as 102°F–104°F (38°C–40°C) by the third to fourth day
of illness. Headache, malaise, and anorexia are nearly universal, and abdominal
pain, diarrhea, or constipation are common. Hepatosplenomegaly can often be
detected. A transient, macular rash of ((rose-colored spots can occasionally be
seen on the trunk.))*Fever is commonly lowest in the ((morning)), reaching a
peak in late ((afternoon or evening.))this clinical presentation is often
confused with: malaria, and typhoid fever should be suspected in a person with
a history of travel to an endemic area who is not responding to antimalarial
medication. Untreated, the disease can last for a month. The serious
complications of typhoid fever generally occur after 2–3 weeks of illness and
may include life-threatening intestinal hemorrhage or perforation.
Laboratory tests:
Infection with typhoid
or paratyphoid fever results in a low-grade septicemia. thus blood
culture is the mainstay of diagnosis
in typhoid and paratyphoid fever, a single culture is positive in only
approximately 50% of cases. Multiple cultures increase the sensitivity and may
be required to make the diagnosis. Bone marrow culture increases the diagnostic
yield to approximately 80% of cases and is relatively unaffected by prior or
concurrent antibiotic use. Stool culture is not usually positive during the first
week of illness, so blood culture is
preferred. & Urine culture has(( no higher
diagnostic yield)) than stool culture for acute cases.
*The Widal test is unreliable but is widely used in developing countries because of its low
cost. It is a serologic assay that may react in patients with typhoid or
paratyphoid fever, but is not
specific and false positives may occur. Serologic
assays are not an adequate substitute
for ((blood, stool, or bone marrow culture.))
((Because there is no definitive serologic test
for typhoid or paratyphoid fever, the initial diagnosis often has to be made
clinically.)) The combination of a
history of risk for infection and a gradual onset of fever that increases in
severity over several days should raise suspicion of typhoid or paratyphoid
fever. Typhoid fever is a nationally notifiable disease
Note :
the ((US
National Library of MedicineNational Institutes of
Health)) puplished comparism
done in Egypt 1996 between paratyphoid((
A ))sever infection and typhoid fever infection which was :
Twenty eight positive blood culture paratyphoid A
fever cases which may mimic the typhoid fever infection and were studied. Forty two positive blood culture
typhoid cases were taken as controls.
Cases and
controls were subjected to:
1) careful history,(( especially young arrival
from developing countries and from same country into urban areas
2) thorough clinical examination,
3) two blood cultures for salmonella,
4) Widal agglutination test,
5) total and
differential white blood count,
6) urine and stool cultures following therapy.
*There was no significant difference in the
clinical picture between acute paratyphoid(( A)) fever and / acute typhoid fever except the:
significant decrease of anorexia (57%), toxic
look (54%), coated tongue (64%) in acute paratyphoid A cases when compared to
acute typhoid cases.
Important note :The prevalence of extraintestinal symptoms in paratyphoid A
cases may mimic viral infections. Three of the 4 classical signs namely; toxic
look (54%), bronchitic chest (50%), splenomegaly (72%) and tympanitis (64%)
were good bed side suggestive clinical diagnostic aids in paratyphoid A cases.
THUS: Blood culture IS the CORNERSTONE of diagnosis of
paratyphoid microbs cases. In 6 (21%), only the second blood sample was
positive stressing the value of multiple cultures. Significant Widal antibody
titre was elicited in only about half (57%) of paratyphoid A cases which was
significantly lower than typhoid cases (83%). Leucopenia was found in only 25%
of paratyphoid A cases. Eosinopenia was constant and is considered as a
diagnostic and prognostic aid.
SO,
No
correlation was elicited between either the height of antibody titre or the
height of leucocytic count and the severity of illness. There was no
significant difference in the response to therapy or the occurrence of
complications between paratyphoid(( A)) cases and typhoid cases. Up to the
current knowledge, this is the first report on comparative study between acute
paratyphoid A fever and acute typhoid fever in Egypt from clinical, diagnostic,
therapeutic and prognostic points of view.
Egypt Public Health
Assoc. at 1996.
Content source:
1st Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)
2nd
Chapter 3: Infectious Diseases
Related to Travel
3d MEDSCPAE-Salmonella typhi and para typhiUpdated: Mar 01, 2018
Author: John L Brusch, MD,
FACP; Chief Editor: Michael Stuart Bronze
Written by :saif alaa alqaisy
30-11-018
