More than a fever: encephalitis due to typhoid fever.

Abstract

Worldwide, 10.9 million cases of typhoid fever occur every year with 116,000 deaths. The largest burden of disease occurs in Africa and Asia but imported cases in travellers, including those visiting friends and relatives, are common. Whilst the majority of cases are uncomplicated and respond well to antibiotics alone, severe disease may occur, particularly in incompletely or untreated cases. Mortality is particularly common where complications, including shock, intestinal perforation or neurological involvement, occur. A case of typhoid fever with severe neurological involvement resulting in coma, seizures and prolonged disability is presented. Despite prompt initiation of appropriate empiric antibiotics, neurological deterioration occurred with a prolonged requirement for mechanical ventilation, severe cerebral oedema and disability. The role for adjunctive corticosteroids and data supporting these therapies is reviewed as is the uncertainty around optimal dose and duration. The pathophysiology of neurological involvement in typhoid fever, with a focus on recent data from animal models, is presented.