Abstract
BackgroundThe bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness.ObjectiveDescribe neurologic features complicating typhoid fever during an outbreak in Malawi-MozambiqueMethodsPersons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate.ResultsBetween March – November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs.ConclusionsNeurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas.
Highlights
Typhoid fever is a bacterial disease caused by infection with Salmonella enterica serovar Typhi (Salmonella Typhi)
Neurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas
40 (13%) persons had objective, focal neurologic findings documented in the medical chart (n = 6) or elicited on examination (n = 34); an additional 27 persons had encephalopathy or altered mental status but did not demonstrate focal neurologic findings and were not included in subsequent analysis
Summary
Typhoid fever is a bacterial disease caused by infection with Salmonella enterica serovar Typhi (Salmonella Typhi) It is transmitted through the fecal-oral route, generally by contaminated water or food. A variety of objective neurologic signs have been documented, including acute neuropsychiatric illness [4,5,6], spasticity and clonus [4,7], ataxia [8,9,10,11,12,13], aphasia [14,15,16], and cerebritis [3,17] These findings have generally appeared as case reports or small case series. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
