Enteric Fever: Pathogens, Clinical Course, and Laboratory Diagnosis

Introduction

Enteric fever, commonly known as typhoid and paratyphoid fever, is a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi. It remains a significant public health concern, particularly in endemic areas with poor sanitation.

Pathogens Responsible for Enteric Fever

• Salmonella Typhi: The primary causative agent of typhoid fever.
• Salmonella Paratyphi: Responsible for paratyphoid fever, often with milder clinical manifestations.

Clinical Course of Enteric Fever

After ingestion, the bacteria colonize the intestinal epithelium before invading the bloodstream, leading to systemic symptoms:

• First Week: Gradual onset of fever, headache, malaise, and gastrointestinal disturbances.
• Second Week: Sustained high fever, abdominal pain, and rose spots on the trunk.
• Third Week: Possible complications such as intestinal perforation, sepsis, or neurological symptoms.
• Recovery Phase: Gradual resolution, though relapse may occur without proper treatment.

Laboratory Diagnosis

Accurate diagnosis is essential for prompt treatment. Common diagnostic methods include:

• Blood Culture: Gold standard for identifying Salmonella.
• Widal Test: Serological test used in endemic regions but with limited specificity.
• PCR-based Assays: More sensitive molecular detection of the pathogen.
• Stool and Urine Cultures: Useful in chronic carriers.

Prevention and Treatment Strategies

Preventive Measures

• Ensure proper sanitation and safe drinking water.
• Encourage vaccination against typhoid.
• Practice food hygiene to prevent contamination.

Treatment Approach

• Antibiotics: Ciprofloxacin, Azithromycin, or Ceftriaxone based on susceptibility patterns.
• Supportive Care: Hydration, fever management, and nutritional support.
• Management of Complications: Surgery may be required for intestinal perforation.

Conclusion

Enteric fever remains a critical global health challenge, particularly in regions with poor sanitation. Timely diagnosis, effective antimicrobial therapy, and preventive strategies, including vaccination, are essential to reducing morbidity and mortality.