Paratyphoid fever C is an acute bacterial intestinal infection. Characteristic signs of pathology are nausea, vomiting, copious loose stools, enlargement of the liver and spleen. The disease is accompanied by severe fever and intoxication. Diagnosis involves the detection of the pathogen in the body’s biological fluids, an increase in the titer of antibodies to bacterial antigens. Etiotropic treatment with the use of antibacterial agents, detoxification is mandatory, fever severity reduction, other measures of pathogenetic and symptomatic therapy.
General information
Paratyphoid fever C is an infectious nosology with a predominantly alimentary pathway of infection. The description of the clinical picture of the disease was independently made by the Iranian researcher Makadam and the Serbian doctor Hirschfeld (1919), a year later the pathogen was simultaneously isolated by the Russian infectious disease specialist Ivashentsov and the German scientist Weigmann. The disease occurs mainly in residents of Asian and Middle Eastern countries. Given the prevalence of HIV in the world and the increased likelihood of infection with this infection, paratyphoid fever C may become one of the urgent problems of modern infectology. The risk group also includes young men, pregnant women and children.
Causes
The causative agent of the infection is the bacterium Salmonella hirschfeldii. Microorganisms are highly resistant to environmental factors. Sources and reservoirs of infection are sick people, carriers, pigs, cows. The way of transmission is food, it is realized when using unboiled milk, raw meat, the entrails of sick animals. In case of contamination of drinking water sources by feces, a waterway of infection is possible. Flies, cockroaches, and other insects can serve as mechanical carriers of bacteria. The contact method is typical under conditions of a low level of hygiene.
The main risk factors are the presence of HIV infection, oncology, other immune deficits, chronic inflammatory diseases of the digestive tract. The danger is the maintenance of small and large cattle near housing, fecal contamination of drinking sources, the use of insufficiently heat-treated meat, labor in slaughterhouses. Unsatisfactory living conditions, chronic malnutrition, neglect of personal hygiene and sanitary standards, especially when working in food production, play a huge role in the spread of the disease.
Pathogenesis
After the penetration of salmonella into the stomach, partial death of microorganisms occurs, the main target of the pathogen are lymphoid formations of the small and large intestines. Bacteria actively multiply inside the lymphatic plaques, enter the systemic bloodstream in small quantities, spread through organs (mainly the reticular–endothelial system). Granulomas form in the affected tissues. Some of the salmonella returns to the mesenteric lymph nodes, some of the pathogens are introduced into the mucosa of the large intestine and form ulcers. Suppression of the cellular link of immunity, especially T-helper cells, is characteristic.
Classification
The classification of paratyphoid fever C is formed taking into account the degree of salmonella invasion within the body. It is believed that in immunocompetent individuals, the infection rarely goes beyond the digestive tract. The main localization of bacteria is the large intestine, the dissemination of the pathogen is expressed slightly. The following forms of the disease are distinguished:
- Gastroenteric. It is characterized by severe gastrointestinal dysfunction, frequent development of dehydration. This type of paratyph is characterized by the formation of catarrhal hemorrhagic, ulcerative necrotic colitis. The duration of the condition does not exceed 4-5 days.
- Typhoid. The clinic copies that of typhoid fever. There is recurrent hyperpyrexia, noticeable adynamia, somnolence, lethargy, headache, jaundice, hepatosplenomegaly. The appearance of roseoles is possible, petechial rash is less common.
- Septic. It is diagnosed in young children, patients with deep immunosuppression. Minimal pathological changes in the intestine, multiple purulent dropouts in the organs are typical. Septic endocarditis is most often formed.
Symptoms
The incubation period is 4-12 days, can be reduced to several hours. The disease begins acutely with chills, attacks of sharp weakness and headache. The body temperature reaches 39.5-40 ° C or more, and is further accompanied by daily fluctuations of 1-2 ° C. Patients with gastroenteritis complain of nausea, repeated vomiting, pain near the navel area, all over the abdomen. The addition of diarrheal syndrome looks like frequent liquid foamy stools with a fetid pungent odor, sometimes with an admixture of blood. Less often, feces look like swamp mud.
With typhoid-like form, there is a sharp inhibition, difficulties in contact with the patient, severe headache. Nausea, diarrhea and vomiting are uncharacteristic, there is pronounced flatulence and constipation. Pinkish spots may appear on the skin of the chest and abdomen, disappearing when pressed. In the septic form, fever reaches high numbers (more than 40 ° C), accompanied by tremendous chills. There may be pain in the bones and joints, impaired consciousness, hallucinations, paralysis, a sharp drop in blood pressure – this is due to purulent dropouts in various organs, the development of infectious and toxic shock.
Complications
Complicated course of paratyphoid fever C is rare. The most frequent complications are observed at 2-4 weeks of the disease, due to pneumonia, endocarditis, perforation of the intestinal wall, peritonitis, infectious and toxic shock, as well as gastrointestinal bleeding. With the gastrointestinal form, severe dehydration is possible up to the development of hypovolemic shock. Complications such as cholangitis, hepatitis, osteomyelitis, arthritis of large joints, toxic myocarditis are less common. In some cases , bacterial carrier and chronization of paratyphoid fever C are formed .
Diagnostics
Verification of the diagnosis of paratyphoid fever C necessarily includes consultation with an infectious disease specialist. If a perforation or intestinal bleeding is suspected, a surgeon’s examination is necessary. It is important to carefully collect an epidemiological history, indications of staying in endemic countries, eating meat and dairy products with an unknown status of heat treatment. Other specialists are involved in the presence of indications. The following laboratory and instrumental techniques are used to confirm the diagnosis:
- Physical data. An objective examination reveals inhibition, a decrease in productive contact. The skin and sclera are subicteric, single roseoles are found. With auscultation of the lungs during the period of complications, there may be a weakening of breathing, and noises in the heart. Palpation of the abdomen – hepatosplenomegaly, rumbling, flatulence, local soreness near the navel and along the course of the large intestine. Assessment of bowel movements is mandatory.
- Laboratory tests. Blood test shows moderate leukopenia, with the progression of the disease – secondary anemia, aneosinophilia, thrombocytopenia. The biochemical parameters were changed in the direction of increasing the activity of ALT, AST and total bilirubin due to the direct fraction. Urinary sediment may contain bile acids and traces of protein. It is recommended to conduct a weekly fecal examination for hidden blood.
- Identification of infectious agents. The isolation of salmonella from the biological materials of the patient is carried out by sowing feces, vomit, gastric lavage, urine, blood and synovial fluid on nutrient media. Serological diagnosis (ELISA) is performed no earlier than the 7th day of the disease in paired serums with an interval of at least 14 days; Vidal’s reaction is mandatory, which in this disease is negative or positive in low titers.
- Instrumental techniques. Chest x-ray allows you to identify complications, make a differential diagnosis. Abdominal ultrasound determines an increase in the size of the liver and spleen, the presence of hemoperitoneum. According to the indications, ultrasound of joints, bones and lymph nodes is performed. Rectoromanoscopy and ECG are indicated in order to clarify the diagnosis, visualization of organ lesions.
Differential diagnosis of paratyphoid fever C is carried out with typhoid fever, paratyphs A and B. Clinically, these diseases are practically indistinguishable, diagnosis requires laboratory confirmation. Paratyphoid fever C is also differentiated with influenza, which has minimal catarrhal manifestations, Ku fever with upper body hyperemia pathognomonic for this pathology and early bronchopneumonia; malaria, which is characterized by temperature paroxysms, severe jaundice, hemolytic anemia.
In acute brucellosis, pronounced intoxication is noted, but without signs of impaired consciousness. Dysentery mainly occurs in the colitic variant, has a characteristic visual and pathohistological picture. In acute pancreatitis, a typical history of alcohol abuse, fatty and carbohydrate-rich foods is revealed. Septic conditions most often have a previously known primary focus of purulent inflammation or data on childbirth outside a medical institution, intravenous drug addiction, etc.
Treatment
All patients with suspected paratyphoid fever C should be hospitalized in an infectious hospital. Strict bed rest is recommended, which is canceled no earlier than 8-10 days of normal body temperature. The diet is aimed at mechanical sparing of the digestive system, excludes alcohol, fatty and fried foods, fresh vegetables, fruits, milk. The drinking regime in the absence of contraindications should be strengthened.
Etiotropic treatment of this paratyphoid fever consists in the appointment of antibiotics, mainly fluoroquinolones, protected penicillins and cephalosporins of the 3rd generation. Previously widely used drugs levomycetin and co-trimoxazole are currently ineffective due to the resistance of the pathogen. Infusion therapy with the use of solutions of chlosol, trisol and their analogues, the introduction of antipyretic drugs (with the exception of aspirin and analogues) is important. For gastroenteritis, sorbents and enzymatic agents are recommended.
Prognosis and prevention
The prognosis is favorable with a satisfactory state of immunity. Complications associated with perforation of the intestinal wall occur in 0.2%, bleeding – in 2% of patients. Relapses have not been described. The vaccine has not been developed. Non-specific prevention includes strict observance of personal hygiene, veterinary control, abstinence from drinking unboiled water, unwashed vegetables, fruits, raw milk and meat products that have undergone insufficient heat treatment. An important role is played by early detection, isolation and treatment of patients, the fight against flies.
