Typhoid and Paratyphoid Fever

1. Caused by Salmonella typhi or salmonella paratyphi; organism is transmitted via contaminated food or water
2. Fever can occur between 5 and 21 days after exposure, and begins with nonspecific symptoms, including abd pain, fever, chills, myalgias
3. First week of illness usually characterized by fevers, bacteremia, followed by the second week of abd pain and a rose/salmon-colored macular rash on the trunk; the third week can include hepatosplenomegaly, peritonitis and intestinal
4. Diagnosis can be challenging: blood cultures are only positive approx 50% of the time, stool cultures can be helpful but may be negative by the time the patient is presenting with more systemic symptoms (also can be positive in a carrier state); most sensitive test is actually a BM biopsy (98% sens)
5. Treatment with a FQ for 7-10 days is recommended, except in pts with travel to Southeast Asia, where FQ-resistance is high (use azithro instead)
6. Prophylaxis includes an oral or parenteral live vaccine, but protection is only about 60% (does not cover paratyphoid strain)
   

(Victoria Kelly MD, 9/9/10)