typhoid encephalopathy

 Q: Which one intervention may make a difference of life and death in "typhoid encephalopathy"? 

 Answer: Administering IV dexamethasone 

Although headache is the most common symptom in typhoid, it may progress to "typhoid encephalopathy." In this advanced neuro stage patient may develop altered mental status such as delirium, confusion, obtundation, or stupor. Once a patient develops "typhoid encephalopathy," the mortality is very high. Administration of intravenous dexamethasone if there is a sign of encephelopathy decreases mortality by more than 50 percent.

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References:

1. Chisti MJ, Bardhan PK, Huq S, et al. High-dose intravenous dexamethasone in the management of diarrheal patients with enteric fever and encephalopathy. Southeast Asian J Trop Med Public Health 2009; 40:1065.

2. Hoffman SL, Punjabi NH, Kumala S, et al. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med 1984; 310:82. 

3. Butler T, Islam A, Kabir I, Jones PK. Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. Rev Infect Dis 1991; 13:85.