Paratyphoid is an infectious disease caused by pathogens from the Salmonella enterica group. As the disease progresses, constipation and diarrhea occur. The symptoms are similar to those of typhoid, but are not quite as pronounced.
What is paratyphoid?
Paratyphoid is a weakened form of the infectious disease typhoid. The causative agent here is Salmonella paratyphi.
The pathogens are distributed worldwide, but infections are more likely to be found in countries with poor hygiene conditions. Symptoms of the disease include headaches, rashes, diarrhea, constipation and hair loss. See ezhoushan for What does Knee Osteoarthritis Stand for.
There is a high fever. Some patients become permanent excretors after infection with paratyphoid.
Causes
The disease is caused by the pathogen Salmonella paratyphi. This belongs to the Salmonella enterica family and can be present in serotypes A, B and C. The causative agent is gram-negative bacteria. They are motile and facultatively anaerobic. Salmonella paratyphi is distributed worldwide. Around 5.5 million people in the world contract paratyphoid every year.
The highest numbers of cases are recorded in Africa, South America and southern Asia. In 2006, 75 cases of paratyphoid in Germany were reported to the Robert Koch Institute. Around 75 percent of the diseases were imported from India, Turkey or Serbia. The pathogen reservoir for Paratyphi-type Salmonella is exclusively humans. Long-term excretors and asymptomatic patients in particular play an important role in the spread.
Long-term excretors are people who permanently excrete the pathogen with the stool. In order to receive the status of permanent excretor, salmonella must still be detectable in the stool ten weeks after the onset of the disease. Infection with Salmonella paratyphi occurs primarily through ingestion of contaminated water or contaminated food. Direct transmission from an infected person to another person is also conceivable. However, since this must take place fecal-orally, this transmission path 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 sufferers remain asymptomatic for the rest of their lives.
Symptoms, Ailments & Signs
The disease begins with general symptoms such as aching limbs, a slight increase in temperature or headaches. Within two to three days, the fever rises to up to 39 degrees Celsius. Those affected feel very ill. Constipation, diarrhea, vomiting, nausea and abdominal pain occur. Typical for typhoid and paratyphoid are bright red skin lesions on the abdomen.
These are also known as roseols. However, they rarely occur. Relative bradycardia also occurs in some cases. Normally, when you have a fever, your heart rate increases by ten beats per minute for every degree of increase in temperature. In the case of a relative bradycardia, this pulse adaptation remains open. The temperature is elevated, but the pulse is normal. Complications such as peritonitis, inflammation of the bile ducts, heart inflammation or intestinal bleeding can occur.
Intestinal perforations or meningitis are also conceivable complications. If paratyphoid is untreated, the convalescence period is very long. If subefebrile temperatures persist even after the symptoms have subsided, this can be an indication of a recurrence. Multiple recurrences are also possible. As a rule, however, the disease is over after four to ten days. A survived infection leaves about a year of immunity.
Diagnosis & course of disease
Paratyphoid infections should be included in the differential diagnosis, especially after travel or stays abroad. In the laboratory, shifts to the left in the blood count and leukopenia provide evidence of an infection with Salmonella paratyphi.
However, only the detection of the pathogen is conclusive. Detection is by culture from the blood. The Widal test can also be used to detect antibodies against the pathogen. While this procedure is very simple and quick, it is not particularly specific and sensitive. It is therefore only used in connection with a clinically proven infection.
Complications
Paratyphoid fever causes those affected to suffer from the symptoms and complaints of gastroenteritis. These complaints have a very negative effect on the patient’s quality of life and can make everyday life significantly more difficult. The disease primarily causes diarrhea and constipation. Nausea and vomiting can also occur, and in most cases those affected also suffer from relatively severe abdominal pain.
There is also fever and very severe pain in the extremities and in the 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. Inflammation of the meninges also occurs, which in the worst case can lead to death if left untreated.
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, with no particular complications. The patient’s life expectancy is also not affected if the treatment is successful. Other inflammations caused by paratyphoid fever may also need to be treated.
When should you go to the doctor?
If you develop a high fever, gastrointestinal problems or feel very unwell, we recommend that you see a doctor. Paratyphoid also manifests itself through headaches and body aches as well as the characteristic reddish spots on the chest, stomach and back. A whitish coating on the tongue is a clear indication of paratyphoid fever and must be examined by a doctor immediately so that any complications can still be averted. Anyone who has recently eaten eggs, ice cream and other foods with an increased risk of salmonella should have the symptoms mentioned immediately examined by a doctor.
Contact with stool, urine and other substances that may already be contaminated is also a risk factor that indicates an infection with paratyphoid or another pathogen and must be clarified by a doctor. The paratyphoid is treated by the family doctor or a specialist in internal diseases. Children are first examined by the responsible pediatrician, who can then initiate measures directly or refer the parents to a suitable specialist. Close consultation with the doctor should be maintained during treatment.
Treatment & Therapy
Paratyphoid fever is always treated with antibiotics. Broad-spectrum antibiotics are usually used. But the gyrase inhibitor ciprofloxacin is also used. The duration of therapy is about two weeks. With antibiotic therapy, the mortality rate is less than one percent. Complications rarely occur with this form of therapy.
Long-term shedders are also treated with antibiotics. A dose over a period of at least one month is recommended. If the long-term excretors also suffer from gallstones, it may be necessary to remove the gallbladder.
Outlook & Forecast
The typhoid-like paratypus can take a mild as well as a severe course. The prognosis is correspondingly different. If the clinical picture is severe, the paratyphoid patient must be treated with antibiotics. This should be done in a clinic.
The affected person can only be treated on an outpatient basis if the course is mild. However, this requires impeccable hygienic care. Patients with paratyphoid need to be isolated from other people. The prognosis improves with the care with which nurses treat the patient. The problem, however, is the increasing number of antibiotic resistances. These complicate the successful treatment of paratyphoid fever. The risks of failed treatment are higher than they used to be.
It can take days for treatment to take effect. In order to improve the chances of curing paratyphoid fever, antibiotic therapy should last for a sufficiently long time. Paratyphoid recurrences must be ruled out. Complications such as intestinal bleeding and intestinal perforations are common. Such difficulties occur in those affected who cannot be treated successfully or who are only given antibiotic therapy at a late stage.
There is a high mortality rate from paratyphoid complications. Emergency surgery can save the lives of some victims. However, postoperative complications are not uncommon. The prognosis is best if paratyphoid fever is detected early and treatment begins early. This reduces the mortality rate to one percent.
Prevention
Paratyphoid is most commonly transmitted through drinking water. Tap water should therefore not be drunk in areas where the disease is widespread. 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 goes for seafood.
A vaccine is also available for typhoid. There is no vaccination against paratyphoid. To protect the environment, persons suffering from paratyphoid should not be involved in food production. This also applies to permanent dropouts. They are prohibited from producing, treating and placing certain foods on the market.
These foods include sprouts, meat, meat products, milk, dairy products, egg products, infant formula, ice cream, baked goods with underheated fillings, deli salads, raw salads and mayonnaise. Likewise, sick people are not allowed to stay in community facilities such as schools or kindergartens.
Aftercare
Paratyphoid aftercare first involves strengthening the immune system, which has been weakened by the disease. The patients slowly get used to everyday stress again, although intensive sport should initially be avoided. The doctor specifies when those affected can return to physically demanding activities. A healthy diet supports the regeneration of the body after paratyphoid.
The restoration of the intestinal flora is also of particular importance. The stomach and intestines are sometimes severely affected by paratyphoid and are still more susceptible to digestive problems and pathogens weeks to months after the actual illness. For example, taking lactic acid bacteria can help to rebuild the intestinal flora, although the doctor treating you should be consulted in any case.
Diet also plays an important role in aftercare. For a few weeks after the paratyphoid, patients pay particular attention to their food choices and avoid irritating foods, such as those that are too spicy. Great importance is also attached to the preparation of food so that any germs present are killed as far as possible.
Meals that are gentle on the stomach include well-cooked food that facilitates digestion and supports the regeneration of the stomach and intestines. Appropriate and individually tailored prescriptions are also available from the treating doctor or a nutritionist.
You can do that yourself
In the case of persistent diarrhea and frequent vomiting, those affected must ensure that they drink enough fluids. Still water and sugar-free teas are ideal. If necessary, a special glucose-electrolyte mixture from the pharmacy can also be used. Grated apples, bananas and taking probiotics to cleanse the intestines also provide relief.
To reduce nausea and vomiting, a particularly light diet with several small portions spread over the day is recommended. In addition, peppermint and ginger tea can be drunk against nausea and loss of appetite. Alcohol and nicotine should initially be avoided entirely. Furthermore, sufficient rest is to be ensured.
Head massages, peppermint oil applied to the temples and fresh air help with mild headaches. If the pain is severe, painkillers can also be taken after consultation with the doctor treating you. At the same time, they also lead to a reduction in the fever that usually also occurs. However, this can also be reduced with cold calf compresses, by wearing light clothing and with elderberry or linden blossom tea.
The infectious paratyphoid fever also requires sustainable hygiene to avoid infecting third parties. The most important measures include regular and thorough hand washing, especially after defecation, careful cleaning of used sanitary items and washing clothes, towels and bed linen as hot as possible.