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Typhoid and paratyphoid—enteric fever 

Typhoid and paratyphoid—enteric fever
Chapter:
Typhoid and paratyphoid—enteric fever
DOI:
10.1093/med/9780198729228.003.0122
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date: 26 June 2019

Typhoid and paratyphoid fever (enteric fever) is a systemic infection caused by Salmonella enterica Typhi and Salmonella enterica serovar Paratyphi A. The disease is transmitted by the faecal–oral route. It is commonest in children and young adults and is prevalent in areas with inadequate sanitation and poor hygiene and in travellers returning from such regions. Enteric fever presents with a high fever, malaise, abdominal symptoms (pain, diarrhoea, constipation), accompanied by a dry cough, headache, and hepatosplenomegaly. The major life-threatening complications are gastrointestinal bleeding or perforation and a severely toxic state with altered consciousness and haemodynamic shock. The diagnosis should be confirmed by blood culture, although this is not 100% sensitive. Antibiotic therapy shortens the illness and reduces the risk of complications, but resistance is common. Ceftriaxone is a reliable empiric therapy, and resistance is currently rare. Azithromycin or ciprofloxacin may be appropriate for oral step-down, but only if the laboratory has confirmed that the isolated organism is susceptible. Notification of the public health authorities is essential for appropriate contact tracing. Typhoid is partially preventable with an injectable Vi vaccine or an oral Ty21a vaccine. There is no paratyphoid vaccine. Travellers to endemic areas should be vaccinated before travel and be careful about the food and fluids they consume.

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