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Updated: Sep 8, 2025

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Fiebre entérica (tifoidea y paratifoidea)

Rebecca Kuehn1, Paul Rahden2, Huma Syed Hussain3

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Lancet (London, England)
|September 6, 2025
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Resumen

La fiebre entérica, causada por las bacterias Salmonella Typhi y Paratyphi, es una infección grave que se propaga a través del agua y los alimentos contaminados. La prevención se basa en las vacunas y el saneamiento mejorado.

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Área de la Ciencia:

  • Enfermedades infecciosas
  • Microbiología
  • Salud pública

Sus antecedentes:

  • La fiebre entérica, que abarca la fiebre tifoidea y la paratifoidea, es causada por Salmonella enterica serovars Typhi y Paratyphi.
  • Estas infecciones prevalecen en regiones con infraestructura inadecuada de agua, saneamiento e higiene (WASH).
  • La transmisión fecal-oral facilita la propagación de estas enfermedades debilitantes.

Objetivo del estudio:

  • Proporcionar una visión global de la fiebre entérica, incluidos sus agentes causantes, transmisión, presentación clínica, diagnóstico, tratamiento y prevención.
  • Resaltar los desafíos para diferenciar la fiebre entérica de otras enfermedades febriles.
  • Hacer hincapié en la importancia de los patrones de resistencia a los antimicrobianos y la vacunación en la gestión de enfermedades.

Principales métodos:

  • Revisión de la literatura sobre métodos de diagnóstico, incluidos los cultivos de sangre y médula ósea.
  • Análisis de las opciones de tratamiento recomendadas como la azitromicina, la ciprofloxacina y la ceftriaxona.
  • Evaluación de las estrategias preventivas disponibles, incluidas las vacunas contra la fiebre tifoidea y las mejoras de WASH.

Principales resultados:

  • Los síntomas típicos de la fiebre entérica incluyen fiebre gradual, malestar, dolor de cabeza y mialgia, a menudo complicados por la resistencia a los antimicrobianos.
  • Los cultivos de sangre o médula ósea son diagnósticos de referencia, aunque la sensibilidad del cultivo de sangre es limitada.
  • La aparición de resistencia a la ciprofloxacina y a la ceftriaxona requiere una cuidadosa selección del tratamiento en función de los patrones locales.

Conclusiones:

  • El tratamiento eficaz de la fiebre entérica requiere un diagnóstico preciso, una terapia antimicrobiana adecuada guiada por datos de resistencia y estrategias de prevención sólidas.
  • La vacunación, particularmente con vacunas de tifoide Vi-conjugado, junto con mejoras sustanciales en WASH, son cruciales para controlar la fiebre entérica.
  • La vigilancia continua de la resistencia a los antimicrobianos y las intervenciones de salud pública son esenciales para combatir la carga mundial de la fiebre entérica.