PARAPHRASE B: CHARACTERISTICS, SYMPTOMS, TREATMENT, PREVENTION - MEDICINE - 2025

The paratyphoid B or Salmonella Schottmuellen is a Salmonella serotype responsible for producing B paratyphoid fever, infectious disease similar to typhoid fever but milder gastrointestinal, but can also cause severe episodes of gastroenteritis, septicemia and meningitis in infants.

Most of the infections caused by Salmonella paratfica B are the result of contamination of food or water with feces from infected patients.

Salmonella (Source: Roinujs via Wikimedia Commons)

Reptiles, including turtles, have been recognized and well studied as a reservoir for Salmonella, thus they are a source of infection for man. Some children who have pet turtles have become infected with salmonella paratype B, developing severe infections.

Many salmonellosis present with mild gastroenteritis and even remit without treatment. However, they can present with severe complications such as septicemia and meningitis, particularly in young children, the elderly and immunosuppressed patients, and can have fatal outcomes.

characteristics

In developed countries, most cases of enteric fevers caused by Salmonella typhus or paratype are caused by people who have traveled or come from endemic areas or areas where these infections are very common.

Studies carried out in England between 2007 and 2010 on epidemiological surveillance of cases of typhoid and paratyphoid fever, show that most of the cases were of people who traveled to endemic areas or who were in contact with people from endemic areas.

These studies showed that they were most commonly infected with serotypes of typhus and paratype A and the lowest incidence (4%) was with serotype B-paratype. In the case of paratype B patients, the average onset of symptoms was during travel or in the 21 days after the return from endemic areas.

In France, in the 1990s, there were two outbreaks caused by goat cheese made from unpasteurized goat's milk and contaminated with Salmonella paratfica B. The cases presented as gastroenteritis and septicemia and the source of goat's milk contamination was not identified.

Source

The most important source of contamination with S almonella paratifica B is the consumption of contaminated water, ice or food, especially raw food and those that were washed with contaminated water. The contamination generally comes from human feces from sick patients or healthy carriers.

However, the origin of an infection may come from contamination with feces of reptiles carrying Salmonella paratfica B. Contamination with flies that may land on contaminated food has also been described.

Turtles, for example, can have Salmonella in their intestinal tract without being sick, being able to distribute it through faeces through water or any surface in contact with it.

Turtle photography (Image by Capri23auto on Pixabay.com)

Many Salmonella serotypes associated with salmonellosis have been found in reptiles. These include: Salmonella Paratyphi B (S. Paratyphi B), S. Poona, S. Pomona, S. Marina, S. Stanley, S. Litchfield, S. Newport, and the more common serotypes S. Typhimurium and S. Enteritidis.

Among reptiles, turtles represent a special interest because they are a risk to the health of young children as they are frequently kept as pets.

Paratyphoid serotype B transmitted by tortoises can cause gastroenteritis or enteric fever and cause serious complications in young children or immunosuppressed patients, including septicemia and meningitis.

Symptoms and diagnosis

There are a series of clinical, laboratory and epidemiological criteria that allow defining cases of typhoid or paratyphoid fever.

Clinical criteria

Person with prolonged fever and at least two of the following four manifestations:

- Headache.

- Relative bradycardia.

- Dry cough.

- Diarrhea or constipation, general malaise or abdominal pain.

Paratyphoid fever B, when it presents as enteric fever, has the same symptoms as typhoid, but milder. However, it can present as gastroenteritis with frank diarrhea or with some complications such as meningitis and septicemia, as explained above.

Laboratory criteria

Isolation of Salmonella paratfica B from a blood or stool sample.

Epidemiological criteria

At least one of the following three epidemiological relationships:

- Exposure to a common source: exposure to the same source or vehicle of infection as a confirmed case.

- Person-to-person transmission: person who has had close contact with a laboratory-confirmed case.

- Exposure to contaminated food or water: person who has consumed laboratory-confirmed contaminated food or products from a laboratory-confirmed infected or colonized animal.

Treatment

Many B paratyphoid infected cases that present as mild gastroenteritis resolve even without treatment, simply with rest and oral rehydration.

In the case of more severe gastroenteritis, parenteral rehydration and antibiotics may be required.

There is an extensive list of antibiotics that can be used in these cases, among these we can name the following:

- Amoxicillin / Clavulanic acid

- Tetracycline

- Streptomycin

- Kanamycin

- Gentamicin

- Nalidixic acid

- Ciprofloxacin

- Chloramphenicol

- Trimethoprim / sulfamethoxazole

- Compounds derived from sulfonamide such as sulfadiazine, sulfathiazole and sodium sulfamerazine.

Treatment will depend on the resistance of the strains involved and the severity and type of infection. In some cases, such as meningitis complicated with brain abscesses, treatments must be prolonged for at least 4 weeks to avoid relapses.

Prevention

The prevention and control of salmonellosis in general and specifically those that cause typhoid and paratyphoid fever, are in charge of the health authorities, which are the entities in charge of epidemiological surveillance, detection, diagnosis, treatment and monitoring of cases and possible contacts.

The health authorities are also responsible for tracing the origin or source of contamination in order to take the relevant health measures.

In these cases, sick people who are not hospitalized will not be able to attend schools, jobs or nurseries until the health authorities indicate it.

Infected people will not be able to handle food, care for children, the sick or residential care until the health authorities indicate it.

People who travel to endemic areas should avoid street foods and beverages, should not eat raw food whenever possible, should not consume ice, and should preferably drink packaged or treated water.

Fruits and vegetables should be washed with boiled or bottled water and it is advisable to wash your hands before eating, drinking or smoking or handling any food or drink.

References

1. Balasegaram, S., Potter, AL, Grynszpan, D., Barlow, S., Behrens, RH, Lighton, L.,… & Lawrence, J. (2012). Guidelines for the public health management of typhoid and paratyphoid in England: practice guidelines from the National Typhoid and Paratyphoid Reference Group. Journal of Infection, 65 (3), 197-213.
2. Denny, J., Threlfall, J., Takkinen, J., Lofdahl, S., Westrell, T., Varela, C.,… & Straetemans, M. (2007). Multinational Salmonella Paratyphi B variant Java (Salmonella Java) outbreak, August – December 2007. Euro Surveill, 12 (12), E071220.
3. Desenclos, JC, Bouvet, P., Benz-Lemoine, E., Grimont, F., Desqueyroux, H., Rebiere, I., & Grimont, PA (1996). Large outbreak of Salmonella enterica serotype paratyphi B infection caused by a goats' milk cheese, France, 1993: a case finding and epidemiological study. BMJ, 312 (7023), 91-94.
4. Hernández, E., Rodriguez, JL, Herrera-León, S., García, I., De Castro, V., & Muniozguren, N. (2012). Salmonella Paratyphi B var Java infections associated with exposure to turtles in Bizkaia, Spain, September 2010 to October 2011. Eurosurveillance, 17 (25), 20201.
5. Levine, MM, Ferreccio, C., Black, RE, Lagos, R., Martin, OS, & Blackwelder, WC (2007). Ty21a live oral typhoid vaccine and prevention of paratyphoid fever caused by Salmonella enterica Serovar Paratyphi B. Clinical Infectious Diseases, 45 (Supplement_1), S24-S28.
6. Nagano, N., Oana, S., Nagano, Y., & Arakawa, Y. (2006). A severe Salmonella enterica serotype Paratyphi B infection in a child related to a pet turtle, Trachemys scripta elegans. Japanese journal of infectious diseases, 59 (2), 132.
7. Wahid, R., Simon, R., Zafar, SJ, Levine, MM, & Sztein, MB (2012). Live oral typhoid vaccine Ty21a induces cross-reactive humoral immune responses against Salmonella enterica serovar Paratyphi A and S. Paratyphi B in humans. Clin. Vaccine Immunol., 19 (6), 825-834.