Enteric Fever (Typhoid/Paratyphoid): Symptoms, Diagnosis & Treatment

Enteric fever = systemic illness from Salmonella enterica serovars Typhi (typhoid) and Paratyphi A/B/C (paratyphoid). Endemic in areas with poor sanitation.

Transmission

Fecal-oral: contaminated water/food, chronic carriers (gallbladder colonization). Incubation: 6–30 days (avg 8–14).

Clinical Features

Feature	Typhoid	Paratyphoid
Onset	Insidious (step-ladder fever)	Similar, often milder
Fever	39–40°C sustained	Similar
GI	Constipation > diarrhea; abdominal pain	Diarrhea more common
Rash	Rose spots (trunk, 25%)	Less common
Neuro	Confusion, delirium, meningitis	Rare
Complications	Intestinal perforation, hemorrhage, encephalopathy	Similar but lower rate

Diagnosis

• Blood culture (gold standard; 40–80% sensitivity early)
• Bone marrow culture (90% sensitivity; even on antibiotics)
• Stool/urine culture (later weeks)
• Widal test: low specificity; not recommended alone
• PCR: emerging, not widely available

Treatment

• Uncomplicated: Ceftriaxone IV/IM or azithromycin PO (7–10 days). Fluoroquinolones if susceptible.
• Severe/complicated: Ceftriaxone + azithromycin; ICU support.
• Carriers: 4–6 weeks antibiotics; cholecystectomy if gallstones.

Prevention

• Typhoid vaccines: Vi polysaccharide (IM, 2 yr), Ty21a oral (4 doses, 5 yr), TCV (conjugate, single dose, longer protection).
• Safe water, food hygiene, sanitation, handwashing.