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Abdominal typhoid and paratyphoid
Typhoid combines the febrile infectious diseases typhoid abdominalis and paratyphoid caused by certain Salmonella, which cause severe diarrhea. The diseases recorded in Germany are in most cases introduced travel sicknesses that were transmitted due to poor hygiene conditions. Serious complications can occur, which is why antibiotic therapy and often hospitalization are essential. In order to limit the spread to people, a notification obligation and certain isolation measures apply to infected and potential carriers.
Typhoid is a cyclical infectious disease that is transmitted by pathogens from the family of enterobacteria, so-called salmonella. The term typhoid derives from the Greek "typhos" for haze, fog or in a figurative sense also vertigo. This describes the typically foggy-confused state of consciousness that occurs in the course of the disease. Affected people usually show serious impairments of their general condition with fever and gastroenterological symptoms, especially diarrhea. Serious complications can occur, which in very rare cases can lead to death.
A distinction is made between Thyphus abdominalis (belly typhus) and Paratyphus due to different serotypes of the disease-causing Salmonella.
The pathogens are widespread worldwide, with far more diseases being recorded in countries with poor hygiene conditions. According to current estimates by the Robert Koch Institute (RKI), a total of twenty-two million new cases of typhoid fever (with approximately two hundred thousand deaths) occur every year. Around 5.5 million new infections are assumed for paratyphoid fever every year.
In Germany, the number of illnesses has decreased significantly in recent decades. Most of the diseases reported in Germany can be traced back to trips to countries of infection (especially Asia). In 2014, RKI had fifty-eight cases of abdominal typhoid and 26 cases of parathypus.
According to the Infection Protection Act (lfSG), typhoid fever is a notifiable infectious disease that must be reported by name if suspected. If symptoms occur after traveling abroad (especially to North Africa, South America, Southeast Asia and India), a medical examination should be carried out immediately. Other tropical diseases (e.g. malaria) and intestinal infections must also be taken into account.
A travel vaccination for stays in high-risk countries provides extensive protection against the disease.
Paratyphus is an easier course with similar but less pronounced symptoms than typhoid abdominalis. In the case of a disease despite current vaccination protection, only weak symptoms usually appear (typhoid levissimus).
Abdominal typhoid symptoms
At the beginning, those affected often feel very weak and weak and complain of non-specific symptoms such as drowsiness, headache, abdominal pain and body aches. Sometimes the body temperature rises. Usually the fever rises gradually and after a few days very high temperatures reach over forty degrees. The high fever can last up to three weeks (continuous fever).
In the early stages, the typical light red, pinhole-sized rashes (roseoles) on the trunk of the body are rarely seen. A slow heartbeat (bradycardia) can also occur.
The symptoms of the digestive tract vary from initial constipation to mushy diarrhea. Nausea and vomiting are also possible.
In most cases, with appropriate treatment, there is an improvement after three to four weeks. If the temperature has been elevated for a long period of time, the disease is likely to recur.
Severe courses are rare, with complications such as ulcers, bleeding and perforation of the intestinal wall, necrosis, abscesses or thromboembolic events. There is a risk of peritonitis (inflammation of the peritoneum). Neurological complications (meningitis) and inflammation of the bone marrow (osteomyelitis) or heart (endocarditis) can also arise. Children in the first year of life have an increased risk of complications.
Symptoms of paratyphoid
Abdominal pain, diarrhea as well as nausea and vomiting can be expected in this mostly mild course. The fever curve usually does not exceed thirty-nine degrees and the symptoms go back after about four to ten days.
Typhoid is transmitted via special Salmonella bacteria. In Tyhpus abdominalis there is an infection with Salmonella enterica serotype Typhi, while Paratyphus is due to Salmonella enterica serotype Paratyphi A, B and C.
The pathogens are taken in orally. This happens primarily through the indirect infection path through water or food that is contaminated with the bacteria. A direct infection, for example by shaking hands, is also possible.
Contamination occurs through excretions (urine and stool) in humans, because humans serve the bacteria as a pathogen reservoir. Not only do acutely ill people secrete the germs, but infected excretions can still occur weeks after the disease. About two to five percent of those affected even become lifelong "long-term eliminators", which are an important source of infection. Two thirds of these permanent separators belong to the bile separators, one third to the small intestine separators.
How many germs are needed to cause a disease varies greatly from person to person. The incubation period for belly typhus can vary greatly depending on the dose and is approximately three to sixty days. Usually the symptoms appear after one to two weeks. Paratyphoid is faster and the first signs appear after one to ten days.
In febrile diseases with high temperatures that last for four days and are without further findings, typhoid and paratyphoid must be considered in the medical diagnosis. This is especially true after trips abroad (to areas with an increased risk of typhoid).
Laboratory results from a blood test can provide information on the diseases, such as leukopenia (leukocyte deficiency) with aneosinophilia (increase in eosinophilic granulocytes as special leukocytes) or an increased occurrence of granulocyte precursors.
A reliable finding can be made via the pathogen detection, ideally with a blood culture at a later stage with continuous fever. The determination of antibodies in blood serum is easier in the detection procedure, but is not sufficient for a valid confirmation of the disease.
All those affected should be treated with antibiotics. The antibiotic ciprofloxacin, which must be administered for at least two weeks, is particularly suitable for successful therapy in adults. Alternatively, broad-spectrum antibiotics from the group of cephalosporins (for example ceftriaxone) can also be used. In addition, co-trimoxazole and amoxicillin are suitable for combating typhoid pathogens.
Successful therapy is particularly evident when therapy is started early. Multi-resistant germs are an increasing problem in treatment. Especially in the endemic areas, corresponding antibiotic treatments often have no effect.
Due to possible complications, hospitalization is advisable, unless it is an easy course. The patients are accommodated in single rooms according to strict hygienic rules. After discharge, several stool samples are examined for pathogens by the health department over a longer period. Special rules must be followed for long-term eliminators and it is recommended that ciprofloxacin be extended to one month. Gallbladder removal may be necessary.
Once the disease has passed, immunity can be expected for around a year, with the dose level playing an important role in every new infection.
Treatment ban for alternative practitioners
According to paragraph thirty-four of the Infection Protection Act, typhoid is prohibited from treatment for alternative practitioners. Those affected can only be treated by doctors. However, alternative practitioners are trained to recognize the disease and are among those who are obliged to report by name.
In order to best prevent typhoid disease, general hygiene rules must be observed. This includes regular hand washing (and disinfecting) and, in risk areas, above all avoiding tap water and the ice made from it. The general rule for dishes is not to consume raw or insufficiently heated food or unpeeled fruit (also in the form of fresh juices).
Active immunization by means of swallowing vaccine (live vaccine) or injection (dead vaccine) is considered effective protection for around sixty percent of those vaccinated for one to three years. Vaccination is generally well tolerated.
In the case of sick people, or if there is suspicion of a disease, provisions of the Infection Protection Act come into force, in which the corresponding persons may not be involved in the production, treatment or transfer of certain foods. There is also a ban on employment for those affected if they work in community facilities and have personal contact there. In addition, the facilities of persons cared for there may not be visited in the event of illness. These regulations apply until a medical certificate or the health authority excludes a further risk of transmission. (jvs, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Pschyrembel: Clinical dictionary. 267th, revised edition, De Gruyter, 2017
- Herold, Gerd and co-workers: internal medicine. Self-published by Gerd Herold, 2019
- Robert Koch Institute (ed.): RKI guide Thypus abdominalis, parathyphus, as of February 8, 2019, rki.de
- Law on prevention and control of infectious diseases in humans (Infection Protection Act, IfSG), gesetze-im-internet.de
ICD codes for this disease: A01ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.