Paratyphoid fever (patient information)

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Overview
Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella enterica serotype Typhi. Paratyphoid fever is a similar illness caused by S. Paratyphi A, B, or C.

What are the symptoms of (condition)?

 * The incubation period of 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.
 * Liver and spleen enlargement can be seen.
 * 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. 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 intestinal hemorrhage or perforation, which can be life threatening.

Who is at highest risk?
Paratyphoid fever can occur in any age group and is food and water borne

When to seek urgent medical care?
If you feel that you are developing symptoms suggestive of paratyphoid fever call your doctor

Diagnosis
Because there is no definitive serologic test for typhoid or paratyphoid fever, the 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.
 * A single blood culture is positive in only half the cases. Stool culture is not usually positive during the acute phase of the disease. Bone marrow culture increases the diagnostic yield to about 80% of cases. The Widal test is an old serologic assay for detecting IgM and IgG to the O and H antigens of salmonella. The test is unreliable but is widely used in developing countries because of its low cost. Newer serologic assays are somewhat more sensitive and specific than the Widal test but are infrequently available.

Treatment options

 * Empiric treatment in most parts of the world would use a fluoroquinolone, most often ciprofloxacin. However, resistance to fluoroquinolones is highest in the Indian subcontinent and increasing in other areas. Injectable third-generation cephalosporins are often the empiric drug of choice when the possibility of fluoroquinolone resistance is high. Patients treated with an appropriate antibiotic may still require 3–5 days to defervesce completely, although the height of the fever decreases each day. Patients may actually feel worse when the fever starts to go away. If fever does not subside within 5 days, alternative antimicrobial agents or other foci of infection should be considered.

Diseases with similar symptoms
Typhoid fever

Where to find medical care for (condition)?
Directions to Hospitals Treating Condition

Possible complications
Septicemia (spread of infection to body through blood).