Published Date: 2004-10-19 23:50:00
Subject: PRO/EDR> Paratyphoid fever - Israel ex India
Archive Number: 20041019.2840
PARATYPHOID FEVER- ISRAEL EX INDIA
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon, 18 Oct 2004 10:58:36 -0400
From: Steve Berger <email@example.com>
During the past 2 months, 10 Israeli tourists developed septicemia
following return from northern India. Quinolone-resistant _Salmonella
paratyphi_ A was recovered from blood culture in all cases. The source of
infection and extent of this phenomenon are unclear. Kindly report similar
cases to ProMED.
Dr. Steve Berger
Tel Aviv Medical Center, Israel
[Paratyphoid fever is similar to typhoid fever, in that both are
enteric-fever types of disease, although the former is generally less
severe. The paratyphoid salmonellae are divided into A, B, and rarely
C. _Salmonella paratyphi_ A is also referred to as _S. enterica_ serotype
paratyphi A. Types B and C also have species -- now serotypes --
_schottmuelleri_ and _hirschfeldii_, respectively. Like typhoid,
paratyphoid is generally considered not to be a zoonosis with humans as the
reservoir, but the paratyphoid bacillus has been isolated from domestic
animals and fish.
In India, paratyphoid A has become an increasing problem, accounting for up
to 45 percent of cases of enteric fever in 1998 (1). Although initially
quite sensitive to antimicrobials, strains have become more resistant to
quinolones; in contrast, _S. typhi_ has manifested resistance for some time.
In a recent report regarding differential risk factors for typhoid and
paratyphoid in Indonesia, the authors found that the infections seemed to
have distinct routes of transmission.(2) Typhoid was associated with
factors within a household (recent case in the house, no soap for
handwashing, sharing of food from the same plate, no toilet in the house),
whereas paratyphoid was associated with sources outside the household such
as food from street vendors and flooding.
1. Sood S, Kapil A, Dash N, et al. Paratyphoid fever in India: an emerging
problem. Emerg Infect Dis 1999;5:483-84.
2. Vollaard AM, Ali S, van Asten HAGH, et al. Risk factors for typhoid and
paratyphoid fever in Jakarta, Indonesia. JAMA 2004;291:2607-15.