Typhoid & Paratyphoid Fevers Explained | Salmonella Typhi & Salmonella Paratyphi

Below we cover the following topics; Typhoid fever, Typhoid meningitis, Typhoid fever with heart involvement, Typhoid pneumonia, Typhoid arthritis, Typhoid osteomyelitis, Paratyphoid fever A, Paratyphoid fever B, and Paratyphoid fever C.

1. Typhoid fever

The bacterium Salmonella typhi, typically spread through contaminated water and food, causes typhoid fever. Typhoid or enteric fever is an infection affecting the gastrointestinal system.

1.1 Symptoms

A patient with typhoid fever can experience:

• high fever;
• stomach pain;
• headache;
• loss of appetite; and
• the patient may also have rose–colored spots on the skin.

1.2 Diagnosis

Laboratory tests of the patient’s stools can detect the Salmonella typhi bacterium.

1.3 Treatment

Treatment includes antibiotics and, in severe cases,–dose of dexamethasone. Providers may vaccinate patients who plan to travel to countries with known poor sanitation.

2. Typhoid meningitis

The bacterium Salmonella typhi, spread through contaminated water and food, causing typhoid meningitis, is typically a complication of typhoid fever. It is an infection that affects the meninges, protective membranes covering the brain and spinal cord.

2.1 Symptoms

A patient with typhoid meningitis can experience:

• meningeal irritation;
• severe headache, and
• a high fever.

Severe infections can lead to seizures, hydrocephalus, subdural empyema, mental retardation, and even death.

2.2 Diagnosis

Laboratory tests include a culture of the patient’s blood and cerebrospinal fluid (CSF) for the Salmonella typhi bacterium.

2.3 Treatment

Treatment generally requires hospitalization and includes antibiotics and other symptomatic treatment; in cases unresponsive to standard antibiotics, the provider may employ ceftriaxone.

Providers may vaccinate patients who plan to travel to countries with known poor sanitation.

3. Typhoid fever with heart involvement

The bacterium Salmonella typhi, spread through contaminated water and food, causing typhoid fever involving the heart, is typically a complication of typhoid fever. It is an infection that causes inflammation of the myocardium, the middle and thickest layer of the heart wall, and the pericardium, the outer covering of the heart.

3.1 Symptoms

A patient with typhoid fever involving the heart can experience:

• myocarditis;
• pericarditis;
• fever; and
• chest pain.

Untreated typhoid fever or disease unresponsive to treatment may cause death.

3.2 Diagnosis

Laboratory tests of the patient’s stools can detect the Salmonella typhi bacterium, and an ECG detects electrocardiographic alterations.

3.3 Treatment

Treatment includes antibiotics; in severe cases, the provider may perform pericardiocentesis or pericardiectomy to remove fluid from around the heart. Providers may vaccinate patients who plan to travel to countries with known poor sanitation.

4. Typhoid pneumonia

The bacterium Salmonella typhi, spread through contaminated water and food, causing typhoid pneumonia, is typically a complication of typhoid fever. It is an infection that affects the lungs.

4.1 Symptoms

A patient with typhoid pneumonia can experience:

• shortness of breath;
• chest pain;
• cough with phlegm;
• fever; and
• the patient may also have typical symptoms of typhoid fever, such as:
  • stomach pain;
  • vomiting;
  • diarrhea; and
  • a sudden change in mental status.

4.2 Diagnosis

Laboratory tests include culture of the patient’s blood and sputum for the Salmonella typhi bacterium. The provider may perform a bronchoscopy with pleural aspiration for diagnostic and therapeutic purposes.

4.3 Treatment

Treatment includes antibiotics and, if necessary, oxygen therapy. Providers may vaccinate patients who plan to travel to countries with known poor sanitation and regions where typhoid is endemic.

5. Typhoid arthritis

The bacterium Salmonella typhi, spread through contaminated water and food, causing typhoid arthritis, is typically a complication of typhoid fever. It is an infection that affects the joints.

5.1 Symptoms

A patient with typhoid arthritis can experience;

• pain;
• swelling;
• heat;
• redness in the joints (mainly in the lower extremities);
• patients may also experience the typical symptoms of typhoid fever, including;
  • stomach pains;
  • vomiting; and
  • diarrhea.

5.2 Diagnosis

Laboratory tests include cultures of the patient’s blood and bone marrow for the Salmonella bacterium. MRIs and X–rays can detect fluid and other changes in the joints.

5.3 Treatment

Treatment includes antibiotics and, in severe cases, surgical intervention. Providers may vaccinate patients who plan to travel to countries with known poor sanitation and regions where typhoid is endemic.

6. Typhoid osteomyelitis

Typhoid osteomyelitis refers to bone inflammation, spread to the bone from an open wound such as a contaminated fracture or through the blood from a typhoid fever infection caused by the bacterium Salmonella typhi, acquired from consuming contaminated water or food.

6.1 Symptoms

Typhoid osteomyelitis is rare in healthy individuals. A patient with typhoid osteomyelitis will experience;

• spine pain;
• bone pain;
• joint pain;
• body aches;
• fever; and
• typical symptoms of typhoid fever; including;
  • stomach pain;
  • vomiting;
  • and diarrhea.

6.2 Diagnosis

Laboratory tests include a patient’s blood and bone marrow culture for the bacterium. MRI and X–ray will reveal destruction and thinning of the bone structure. Laboratory tests include culture of the patient’s blood and examination of bone and bone marrow biopsy samples. MRI and X–rays will show thinning of the bone, abscess, and foci of infection.

6.3 Treatment

Treatment includes antibiotics and, in severe cases, surgical intervention. Providers may vaccinate patients who plan to travel to countries with known poor sanitation and regions where typhoid is endemic.

7. Paratyphoid fever A

The bacterium Salmonella paratyphi A, the most common subtype of S. paratyphi worldwide and typically ingested with contaminated water and food, causes paratyphoid fever, an infection that affects the gastrointestinal system; however, it is less severe than typhoid fever.

7.1 Symptoms

A patient with paratyphoid fever A can experience;

• high fever;
• stomach pains;
• headache;
• loss of appetite;and
• the patient may also have rose–colored spots on the skin.

7.2 Diagnosis

Laboratory tests of the patient’s stools can detect the Salmonella paratyphi A bacterium.

7.3 Treatment

Treatment includes antibiotics. Providers may vaccinate patients who plan to travel to countries with known poor sanitation.

8. Paratyphoid fever B

The bacterium Salmonella paratyphi B (also called S. schottmuelleri), the subtype predominant in Europe and typically spread through contaminated water and food, causes paratyphoid fever, an infection that affects the gastrointestinal system; however, it is less severe than typhoid fever.

8.1 Symptoms

A patient with paratyphoid fever B can experience;

• high fever;
• stomach pains;
• headache;
• loss of appetite;
• the patient may also have rose–colored spots on the skin.

8.2 Diagnosis

Laboratory tests of the patient’s stools can detect the Salmonella paratyphi B bacterium.

8.3 Treatment

Treatment includes antibiotics. Providers may vaccinate patients who plan to travel to countries with known poor sanitation.

9. Paratyphoid fever C

The bacterium Salmonella paratyphi C, a rare subtype seen only in the Far East and typically spread through contaminated water and food, causes paratyphoid fever, an infection that affects the gastrointestinal system; however, it is less severe than typhoid fever.

9.1 Symptoms

A patient with paratyphoid fever C can experience;

• high fever;
• stomach pains;
• headache;
• loss of appetite;
• the patient may also have rose–colored spots on the skin.

9.2 Diagnosis

Laboratory tests of the patient’s stools can detect the Salmonella paratyphi C bacterium.

9.3 Treatment

Treatment includes antibiotics. Providers may choose to vaccinate patients who plan to travel to countries with known poor sanitation.