Typhoid fever masquerading as functional psychosis

While acute confusional states are frequently encountered in typhoid fever, initial manifestation of this illness as "functional psychosis" is very rarely encountered. We describe our experience of three patients seen within a 15-month period, who initially presented as various forms of psychiatric disorders with little evidence of impairment of consciousness, well before the appearance of pyrexia which led to the correct diagnosis. The possible role of less severe or self limiting organic conditions in the genesis of "functional" psychosis in the African population is discussed. The importance of a high index of suspicion in the functional-type psychosis, that might be due to typhoid fever and the need to institute therapy for typhoid fever while investigating (the late appearing fever) in such cases are emphasized.