Comparative study between paratyphoid A and typhoid fever cases

Twenty eight positive blood culture paratyphoid A fever cases were studied. Forty two positive blood culture typhoid cases were taken as controls. Cases and controls were subjected to: 1) careful history, 2) thorough clinical examination, 3) two blood cultures for salmonella, 4) Widal agglutination test, 5) total and differential white blood count, 6) urine and stool cultures following therapy. There was no significant difference in the clinical picture between acute paratyphoid A fever and acute typhoid fever except the significant decrease of anorexia (57%), toxic look (54%), coated tongue (64%) in acute paratyphoid A cases when compared to acute typhoid cases. The prevalence of extraintestinal symptoms in paratyphoid A cases may mimic viral infections. Three of the 4 classical signs namely; toxic look (54%), bronchitic chest (50%), splenomegaly (72%) and tympanitis (64%) were good bed side suggestive clinical diagnostic aids in paratyphoid A cases. Blood culture was the cornerstone of diagnosis of paratyphoid A cases. In 6 (21%), only the second blood sample was positive stressing the value of multiple cultures. Significant Widal antibody titre was elicited in only about half (57%) of paratyphoid A cases which was significantly lower than typhoid cases (83%). Leucopenia was found in only 25% of paratyphoid A cases. Eosinopenia was constant and is considered as a diagnostic and prognostic aid. No correlation was elicited between either the height of antibody titre or the height of leucocytic count and the severity of illness. There was no significant difference in the response to therapy or the occurrence of complications between paratyphoid A cases and typhoid cases. Up to the current knowledge, this is the first report on comparative study between acute paratyphoid A fever and acute typhoid fever in Egypt from clinical, diagnostic, therapeutic and prognostic points of view.