Paratyphoid fever pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Pathophysiology
Paratyphoid fever starts when the bacterium Salmonella typhi is passed from another person due to bad hygiene such as lack of washing hands after using the restroom. Eventually the bacteria passes down to bowel, then penetrating the intestinal mucosa (lining) to the underlying tissue. If the immune system is unable to stop the infection here, bacteria multiplies and spread to the bloodstream, after which the first signs of disease are observed in the form of fever. Bacteria can penetrate further to the bone marrow, liver and bile ducts, and are excreted into the bowel contents. In the second phase of the disease, bacteria penetrates the immune tissue of the small intestine, and the initial symptoms of small-bowel movements begin.
Salmonella typhi can specifically only attack humans, so the infection nearly always comes from contact another human, either an ill person or a healthy carrier of the bacterium. The bacterium is passed on with water and foods and can withstand both drying and refrigeration but by keeping food refrigerated correctly this minimizes the production of the bacterium significantly.
Carriers
Humans and, occasionally, domestic animals are the carriers of paratyphoid fever. Members of the same family can be transient or permanent carriers. In most parts of the world, short-term fecal carriers are more common than urinary carriers.
It is possible to continue to shed Salmonella paratyphi for up to one year and, during this phase, a person is considered to be a carrier. The chronic carrier state may follow acute illness, mild or even sub clinical infections. Chronic carriers are most often women who were infected in their middle age.