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Authors
Source
NIMHANS Journal, Vol 8, No 2 (1990), Pagination: 111-126
Abstract
Fifty-five patients with neurological complications due to Salmonella typhi (S. typhi) infection were studied. Seven (12.7%) of them presented with pyogenic meningitis, 2(3.6%) with cerebral abscess and 46(83.6%) had neurological deficits without pyogenic meningitis. The mean age was 19.24 ± 12 years. The mean duration of illness at the time of admission was 16.4 ± 13 days. Fever was the initial and most prominent symptom in 46(83.6%) and most of them had headache, vomiting, myalgia and/or loose motions. Hepatomegaly and/or splenomegaly was present in 27(49%). The mean interval between the onset of fever and the development of neurological deficits was 9.5 ± 9 days. The neurological deficits included those of pyramidal, extrapyramidal, cerebellar, brain stem, spinal cord and/or peripheral nerves. One had polymyositis. Blood Widal was done in 45 cases and was positive in 43 (95%) of them. The S. typhi was isolated from blood in 21, CSF in 3, cerebral abscess pus in 2, and from other sources in 4. The phage and biotype of isolates was done in 17 patients. The antibiotic sensitivity studied in 25 cases revealed resistance to ampicillin in 5 and to chloramphenicol in 10, while all were sensitive to co-trimoxazole and gentamycin. The lumbar CSF analysis done in 47 patients, was abnormal in 14 (29.7%). The EEG done in 29, was abnormal in 19 (66%) and the abnormalities were subclinical in 1. The ENMG done in 7 patients, was abnormal in 4. The mean duration of hospital stay of 54 patients was 14.8 ± 14 days. At the end of hospital stay 46 of them (83.6%) recovered (completely or partially) and 9 of them (16.4%) died. Seven of them were autopsied. At autopsy, brains showed features of pyogenic meningitis in 3 cases, while the other four had degenerative changes involving the dentato-olivary pathway.
Keywords
Typhoid, Salmonella Typhi, Pyogenic Meningitis, Cerebral Abscess, Bacterial Encephalomyeloradiculopathy
