Paratyphoid A and B are acute infectious diseases that are clinically similar to typhoid fever. Pathogens are mobile bacteria from the genus Salmonella, resistant in the external environment. Disinfectants at normal concentrations kill them in a few minutes. The only source of infection for paratyphoid A are sick and bacterial excretors, and for paratyphoid B, animals (cattle, etc.) can also be the source of infection. Ways of transmission are more often fecal-oral, less often contact-household (including fly). The rise in incidence begins in July, reaching a maximum in September-October, is of an epidemic nature. Susceptibility is high and does not depend on age and sex.
Symptoms and course. Paratyphoid A and B, as a rule, begins gradually with an increase in signs of intoxication (fever, increasing weakness), dyspeptic symptoms (nausea, vomiting, loose stools), catarrhal symptoms (cough, runny nose), roseolous-papular rash and ulcerative lesions of the lymphatic system join intestines.
Features of clinical manifestations in paratyphoid A. The disease traditionally has a more acute onset than paratyphoid B, with an incubation period of 1 to 3 weeks. Accompanied by dyspeptic disorders and catarrhal symptoms, probably reddening of the face, herpes. The rash, as a rule, appears on the 4-7th day of the disease, often plentiful. During the course of the disease, there are traditionally several waves of rashes. The temperature is remitting or hectic. The spleen is not often enlarged. In the peripheral blood, lymphopenia, leukocytosis are often observed, eosinophils persist. Serological reactions are often negative. More likely to relapse than with paratyphoid B and typhoid fever.
Features of clinical manifestations of paratyphoid B. The incubation period is much shorter than in paratyphoid A.
The clinical course is very diverse. When the infection is transmitted through water, a gradual onset of the disease is observed, its relatively mild course. When salmonella penetrates with food and its massive intake into the body occurs, gastrointestinal phenomena (gastroenteritis) predominate with the subsequent development and spread of the process to other organs. With paratyphoid B, more often than with paratyphoid A and typhoid fever, mild and moderate forms of the disease are observed. Relapse is likely, but less common. The rash may be absent or, on the contrary, be abundant, varied, appear early (day 4-7 of the disease), the spleen and liver increase earlier than with typhoid fever.
Treatment. It should be comprehensive, including care, diet, etiotropic and pathogenetic agents, and, according to indications, immune and stimulating products. Bed rest until 6-7 days of normal temperature, from 7-8 days it is allowed to sit, and from 10-11 to walk. Easily digestible food, sparing the gastrointestinal tract. During a fever, it is steamed or given in a pureed form (table No. 4a). Among the products of specific action, the leading place is occupied by chloramphenicol (dosage of 0.5 g 4 times a day) up to the 10th day of normal temperature. To increase the effectiveness of etiotropic therapy, mainly to prevent relapses and the formation of chronic bacterial excretion, it is recommended to carry out it in the process with drugs that stimulate the body’s defenses and increase specific and nonspecific resistance (typhoid-paratyphoid B vaccine).
Prevention . It comes down to general sanitary measures: improving the quality of water supply, sanitary cleaning of populated areas and testing, fighting flies, etc. Dispensary observation of paratyphoid patients is carried out for 3 months.