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[Septic shock with coma revealing typhoid fever]

E Hazouard1, M Ferrandière, B Cattier

  • 1Service de Réanimation médicale, CHU Bretonneau, Tours.

Presse Medicale (Paris, France : 1983)
|October 10, 1998
PubMed
Summary

Typhoid fever, often mistaken for malaria, presents with severe symptoms like septic shock and coma. Early diagnosis and treatment with antibiotics like ceftriaxone are crucial for recovery.

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Area of Science:

  • Infectious Diseases
  • Tropical Medicine
  • Critical Care Medicine

Background:

  • Typhoid fever shares clinical features with malaria, including septic shock, encephalopathy, and leukopenia.
  • Differentiating between these febrile illnesses can be challenging in endemic areas.

Observation:

  • A 20-year-old woman presented with coma, shock, and gastrointestinal symptoms, progressing to multi-organ dysfunction.
  • Initial diagnostic workup, including peripheral blood smear, was negative for malaria, but Salmonella typhi was isolated from blood cultures.
  • The patient developed leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis, and hepatitis.

Findings:

  • Blood cultures confirmed Salmonella typhi infection, indicating typhoid fever as the cause of sepsis.
  • Prompt administration of ceftriaxone, fluid resuscitation, and vasopressors led to clinical improvement.

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  • The patient recovered fully within two weeks of intensive care unit admission.

    • Implications:

    • Typhoid fever should be a key consideration in patients presenting with sepsis, particularly those from endemic regions.
    • Clinical signs such as abdominal pain, prolonged fever, coma, and delayed headache warrant thorough investigation for typhoid.
    • Timely and specific antibiotic therapy is essential for managing severe typhoid fever and preventing complications.