OVERVIEW
Overview
Paratyphoid fever is an acute intestinal infectious disease caused by three types of salmonellae: paratyphoid A, B and C. The clinical manifestations of paratyphoid A and B are similar to typhoid fever, but the disease is milder and shorter. The clinical manifestations of paratyphoid A and B are similar to those of typhoid fever, but are milder and shorter in duration, while those of paratyphoid C are more specific, and may manifest as mild typhoid fever, acute gastroenteritis or septicemia.
Whether medical insurance
Yes, it is
Department
Infectious disease department
Clinical symptoms
Fever, headache, abdominal pain, diarrhea, vomiting, etc.
Hazards
It can develop into septicemia, which can cause septic complications in all parts of the body, and can involve digestive, respiratory and other systems to cause impaired function, and can be life-threatening in severe cases.
Complications
Intestinal hemorrhage, intestinal perforation, hepatitis, toxic myocarditis, bronchopneumonia.
Examination
Blood routine, stool routine, blood culture, bone marrow culture, fecal culture, urine culture, fertilization reaction, etc.
Diagnosis
Sometimes it is not easy to distinguish from typhoid fever, and the diagnosis can only be confirmed by bacterial culture and typhoid fever agglutination test. Separating and culturing Salmonella paratyphi from the patient’s blood, bone marrow, urine, feces and other specimens is the gold standard for diagnosis.
Treatment principle
Combination of antibacterial drug treatment and symptomatic supportive treatment.
Curability
Most of the patients can be cured, but the death rate of patients with intestinal perforation, intestinal hemorrhage, myocarditis and severe toxemia is higher.
Dietary recommendations
High-calorie, high-nutrition, low-slag or no-slag diet.
Important reminders
Early detection and isolation of paratyphoid patients and carriers are important measures to control the epidemic.
Causes
Epidemiology
Perennial circulation, most frequent in summer and fall, with a higher incidence in children.
Etiology
Salmonella paratyphi spreads through the digestive tract to infect humans.
Transmission route
Mainly through the fecal-oral route, with food transmission being more common.
Symptoms and Diagnosis
Typical symptoms
1. The clinical manifestations of paratyphoid A and B are similar to those of typhoid fever, but the disease is milder and shorter in duration. Onset of acute gastroenteritis symptoms such as abdominal pain, diarrhea, vomiting, etc., relieved after 2 to 3 days, followed by increased and fluctuating body temperature, with rare cases of retained fever. The duration of fever is short, about 3 weeks for paratyphoid A and 2 weeks for paratyphoid B. The rash appears earlier. Rash appears earlier, darker in color, slightly more in quantity, and can spread all over the body.2. The clinical manifestations of paratyphoid A are diversified, with fever being the earliest and most prominent symptom, and irregular fever and flaccid fever being more common than episodic fever, followed by headache and malaise, which are more obvious, and are often accompanied by upper respiratory and gastrointestinal symptoms at the early stage of disease, such as coughing, sputum, nausea, vomiting, abdominal pain and distension, which can be easily confused and misdiagnosed or underdiagnosed with upper respiratory infections or gastrointestinal diseases. The clinical manifestations of paratyphoid C are more complex, and can be manifested as mild typhoid fever, acute gastroenteritis type or septicemia type. Acute gastroenteritis type is dominated by gastroenteritis symptoms and has a short course. Septicemia type is common in frail children, with acute onset, chills, high fever, irregular fever pattern, and migratory septic complications in more than half of the patients, with limited septic foci in the lungs, bones, and joints being common, and intestinal hemorrhage and intestinal perforation being rare.
Diagnostic basis
History of unclean eating and drinking about 2 weeks prior to illness. High fever, often with symptoms of acute gastroenteritis such as abdominal pain, diarrhea, and vomiting. Bacterial culture of blood, bone marrow, and pus reveals Salmonella paratyphi to confirm the diagnosis. Hypertrophic reaction test results have some reference value, but the agglutination potency of paratyphoid fever is low, and some of them can be consistently low.
Treatment
Treatment guidelines
Combination of antimicrobial medication and symptomatic supportive therapy. Abscesses may be drained surgically if present.
Drug therapy
Quinolones are the drugs of choice. Commonly used drugs are ofloxacin, ciprofloxacin, levofloxacin, gatifloxacin and so on. Cephalosporins are also the first-line drugs for the treatment of paratyphoid fever, commonly used drugs include ceftriaxone, ceftazidime, cefoperazone and cefotaxime, etc. They are especially suitable for children, pregnant women and lactating women.
Surgical treatment
When paratyphoid C develops abscess, surgical drainage is feasible.
Other treatments
Physical hypothermia is the mainstay for those with high fever.
Prognosis
The prognosis is related to the patient’s condition, age, the presence of complications, the early or late treatment, the treatment method, and the virulence of the pathogenic bacteria. Elderly people, infants and young children have poorer prognosis. Complications such as intestinal perforation, intestinal hemorrhage, myocarditis, and severe toxemia have a higher mortality rate.
Nursing care
Daily care
1. bed rest. 2. isolate according to digestive tract infectious disease. 3. keep skin clean and change position regularly to prevent bedsore and lung infection. 4. take medication according to doctor’s prescription and pay attention to adverse drug reactions.
Diet
High-calorie, high-nutrition, low-slag or no-slag diet. Avoid eating hard, slaggy and indigestible food, so as not to induce intestinal bleeding or intestinal perforation. Do not drink raw water or eat unclean food.