Typhoid and Paratyphoid Fever

Typhoid and paratyphoid fever (enteric fever) have become a travel-associated disease in the industrialized world. The risk to travelers appears to vary by geographic region visited, with travel to the Indian subcontinent accounting for the greatest travel risk. Although the most common cause of enteric fever is Salmonella typhi, among travelers the incidence of disease caused by S. paratyphi may be more significant, as typhoid vaccine only protects against S. typhi. Clinical presentation of patients with S. typhi and S. paratyphi is similar, and no difference was noted among those who contracted the disease despite being vaccinated. Drug resistance reflects the situation in endemic countries, with a steady increase in multidrug resistance patterns. Currently, the recommendation for first-line therapy is ceftriaxone and azithromycin, and where isolates have been found to be quinolone-sensitive, fluoroquinolones can still be given.