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How to manage paratyphoid fever?

Q: My daughter (5 years old) had fever for 7 days. Since fever was not coming down, the doctor advised blood & urine tests. Her Widal test is positive, blood culture reports are still due. The doctor says that she has paratyphoid. I want to know what is difference between paratyphoid & other typhoid. The doctor has prescribed ofloxacin & azithral. With the very first dose her fever has come down. I'd like to know if this is infectious, what precautions one must take, what should I give her to eat & what should I avoid? Can she play around? What will the doctor check in the culture reports?

A:Typhoid fever is caused by the organism Salmonella typhi and paratyphoid fever is caused by Salmonella paratyphi A, B and C. Typhoid fever tends to be more severe than paratyphoid fever. Blood cultures usually confirm the diagnosis and are positive in 40-75% of patients in the first week of illness. Stool and urine cultures become positive after the first week. Because identification of salmonella by culture usually takes several days, several methods of early diagnosis are used. These include immunologic detection of specific antigens and use of PCR. The classic Widal test measures antibodies against O and H antigens of S. typhi and paratyphi A and B. It is usually helpful after 7-10 days of illness. Because many false positive and false negative reactions occur, diagnosis of typhoid fever by Widal test alone is prone to error. Antibiotic therapy is essential in treating typhoid fever. Because of increasing antibiotic resistance, choosing the appropriate empirical therapy before culture reports are available, is problematic and controversial. Reports describe resistance to drugs such as chloramphenicol, ampicillin and co-trimoxazole in about 50-85% of culture isolates of S typhi. Oral ofloxacin is one of the drugs used in treatment, but not routinely recommended for use in children. Combined use of two antibiotics is not justified for the management of typhoid fever. Most children become afebrile only after 5-7 days of antibiotic therapy. If the fever remits with the first dose of the antibiotics, the diagnosis is most likely wrong. Prevention of typhoid fever requires improved sanitation and clean running water. Personal hygiene measures, hand-washing, attention to food preparation practices are necessary to minimise person-to-person transmission and food contamination. 3 types of vaccines are available against typhoid fever. The oral vaccine is not generally recommended in children below 6 years. There is no need to restrict the activities of the child if she is afebrile for 3-4 days.


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