Typhoid Fever Presenting as Acute Psychosis.

Abstract

Enteric fever presenting with atypical manifestations is challenging even to astute clinicians and is not a new occurrence in the tropics. Various authors have highlighted the protean manifestations of this common tropical infection [1, 2, 3]. The emergence of multi-drug resistant strains of Salmonella typhi and the HIV pandemic have altered the spectrum of the disease and made the treatment difficult due to multiple drug resistance. The classical pattern of presentation of continuous fever with “step ladder” rise and relative bradycardia is not common. Though neuropsychiatric complications are reported in as much as 45–76% of patients during every stage of typhoid fever [4, 5, 6, 7, 8], the chance of misdiagnosis or delayed diagnosis of the primary illness is still quite common. Most of such cases are considered to be a part of the “Typhoid toxaemia”, where patients develop delirium and confusion during the initial stages of the disease along with high fever, and generally subsides within 1–2 days of defervescence [8].