The paralytic TO is a serotype of Salmonella, a bacterium responsible for producing a disease called “paratyphoid enteric fever”. The Salmonella It is a Gram negative, facultative anaerobic bacillus that does not develop capsules or spores and is part of the Enterobacteria family.
Salmonella make up a genus of more than 2300 serotypes, of which more than 200 are pathogenic for man, among them "paratypic A". They are mobile, flagellated bacteria that infect humans through the ingestion of contaminated food or water..
Infection by Salmonella paratific A requires a relatively small inoculum. The infection is transmitted to man without an intermediate host. Poor sanitary conditions favor contagion.
There are a number of conditions that increase people's susceptibility to infection by Salmonella, Among those that can be named: history of surgery and chronic inflammatory problems of the gastrointestinal system, decrease in heartburn (the host's first defense barrier) or alteration of the intestinal flora due to recent administration of antibiotics.
The Salmonella paratyphic A produces an enteric fever similar to typhoid fever, but almost always milder.
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Worldwide, typhoid and paratyphoid fever or enteric fevers are generally common in areas of the planet where there are poor sanitary measures and water for human consumption is easily contaminated with sewage..
The areas where these diseases occur most frequently are much of Asia, the Middle East, Africa, Central and South America and part of southern Europe.
The Salmonella paratyphic A enters the host orally and lodges in the terminal or distal ileum (small intestine). These microorganisms have “fimbriae” with which they adhere to the epithelium on the lymphoid tissues of the ileum in Peyer's patches..
If the immune system does not stop the infection, the bacteria multiply and enter the bloodstream causing mild septicemia. At this time the fever and general malaise begin. The bacteria then invade the lymphatic tissue, revealing the characteristic symptoms of the disease.
As paratphic salmonellosis A has as a reservoir man, the source of contagion is food and water contaminated with feces or urine from healthy or sick carriers.
Among the important sources of infection are raw vegetables, green salads, milk and its derivatives, water or ice, shellfish or any other food that has been contaminated with feces or urine. All those raw foods that are washed with contaminated water are potential sources of infection.
The climatic floods that occur in some poor areas are a major source of wastewater contamination of drinking water. These are starting points for many outbreaks.
As the Salmonella paratific A is sensitive to heat, it is recommended to boil water and cook food well in areas where there is danger or risk of contamination.
The symptoms of paratyphoid enteric fever A or paratyphoid fever are similar to those of typhoid fever, but with a prodrome of shorter duration (1 to 10 days) and less severe symptoms. It is of sudden onset and of shorter duration. Relapses occur in approximately 8% of cases.
The most frequent symptoms are the following:
- Sustained high fever.
- Headache.
- General discomfort.
- Decreased appetite.
- Hepatomegaly and splenomegaly (enlargement of the liver and spleen), which can cause abdominal discomfort.
- Dry cough in the early stages of the disease.
- Appearance of a "rash”Or flat pinkish rash that may be visible on the trunk.
- Constipation or diarrhea. Constipation occurs much more frequently in adults, while only 20% of sick adults have diarrhea. In children and the elderly, diarrhea is more common.
The severity of the disease ranges from moderate to severe with multiple complications. People who do not receive treatment can maintain high temperatures for several weeks and in these cases complications are much more frequent. There are very few healthy carriers for this type of salmonellosis..
The complications associated with the greater number of deaths are fluid and electrolyte disorders in children and bleeding and perforations of the gastrointestinal tract in adults. With proper treatment, mortality is very low, less than 1%.
The diagnosis is made by blood culture in the early stages of the disease or by culture of urine and / or feces in later stages and then, using different methods, the corresponding serotype is immunologically identified. Currently, many institutions use the PCR as a diagnostic tool. Polymerase Chain Reaction).
Treatment requires rest, parenteral rehydration in cases of dehydration due to profuse diarrhea, and antibiotics. Thanks to the use of antibiotics and prescribed vaccines, the disease is not lethal.
The treatment of choice is quinolones, specifically ciprofloxacin. Although this has been the treatment of choice, in the last decade and especially in the Asian continent, many cases of resistance have been reported.
Ceftriaxone or cefotaxime, third-generation, broad-spectrum cephalosporins, can also be used. Another antibiotic that has been shown to be effective is azithromycin, which belongs to the group of broad spectrum macrolides..
In many endemic areas, the classic treatment with chloramphenicol or trimethoprim / sulfamethoxaxole is still used, but this treatment is no longer effective due to the resistance that these microorganisms have developed.
The treatment schedule for paratyphoid fever for adults is ciprofloxacin: 1 gram daily for 10 days (orally or IV); ceftriaxone: 2 to 4 grams daily for 14 days (IM or IV route); cefotaxime: 3 to 6 grams daily for 14 days (IV) or azithromycin: 1 gram daily for seven days (oral).
Health authorities must monitor and evaluate family contacts and any other close contact, related to cases already diagnosed..
The sick person should not attend daycare, schools or work until the health authorities give their approval, in order to avoid the risk of contagion.
People who work handling food, caring for or caring for children, in jobs related to health care or residential care, cannot return to their work activities until the doctor in charge of the case in the health service gives his approval..
Some close contacts of the infected person should also be kept under observation and examined by the health authorities until they are sure that they are not infected..
People with typhoid or paratyphoid fever should not prepare food for other people and should not swim in public or private pools, until the health authorities declare them free of the disease.
If you are going to travel to areas where these salmonellosis are common or endemic, you should avoid street foods and drinks, as well as raw foods as much as possible. You should drink boiled or bottled water without ice or use tablets to purify (chlorinate) the water. You should consult your doctor about available vaccines.
You should wash fruits with boiled or bottled water and wash your hands before drinking, eating, or smoking..
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