Isolated cerebellar ataxia: an early neurological complication of enteric fever

Dewan, Pooja; Pooniya, Vishal; Kaushik, Jaya Shankar; Gomber, Sunil; Singhal, Siddharth

doi:10.1179/027249309x12467994693978

Cited by 9 publications

(6 citation statements)

References 11 publications

(16 reference statements)

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“…Typhoid fever is commonly characterized by headache, stomach pain and a sustained high fever. In rare cases, typhoid fever patients have been found to exhibit neurological abnormalities (Dewan et al, 2009 ; Joshi et al, 2011 ; Szabo et al, 2013 ; Talukdar et al, 2013 ). A very high mortality rate, more so in infants, is associated with Salmonella infections of the brain (Drevets et al, 2004 ).…”

Section: Introductionmentioning

confidence: 99%

Salmonella Typhimurium Infection Leads to Colonization of the Mouse Brain and Is Not Completely Cured With Antibiotics

et al. 2018

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Salmonella systemic infections claim thousands of lives worldwide even today. Certain cases lead to an infection in the brain culminating in meningitis and associated neurological abnormalities. Multiple reports have indicated neurological manifestations in patients suffering from typhoid fever during the course of infection and afterwards. While the meanderings of Salmonella systemic infections are fairly well studied, the flow of events in the brain is very poorly understood. We investigated the colonization of various brain parts by Salmonella in mice. It was observed that the bacterium is frequently able to invade various brain parts in mice. Selected mutants namely deletion mutants of key proteins encoded by the Salmonella pathogenicity islands (SPIs) 1 and 2 and ompA gene were also used to decipher the roles of specific genes in establishing an infection in the brain. Our results suggest roles for the Salmonella pathogenicity island (SPI) 1 and outer membrane protein A gene in enabling blood-brain barrier penetration by the pathogen. We further investigated behavioral abnormalities in infected mice and used an antibiotic treatment regime in an attempt to reverse the same. Results show some mice still display behavioral abnormalities and a high bacterial burden in brain despite clearance from spleen and liver. Overall, our study provides novel insights into S. Typhimurium's capacity to invade the mouse brain and the effectiveness of antibiotic treatment on behavioral manifestations due to infection. These observations could have important implications in understanding reported neurological manifestations in typhoid patients.

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Section: Introductionmentioning

confidence: 99%

Salmonella Typhimurium Infection Leads to Colonization of the Mouse Brain and Is Not Completely Cured With Antibiotics

et al. 2018

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“…Neurologic illness has also been described, most frequently as acute encephalopathy or meningitis [3]. A variety of objective neurologic signs have been documented, including acute neuropsychiatric illness [4], [5], [6], spasticity and clonus [4], [7], ataxia [8], [9], [10], [11], [12], [13], aphasia [14], [15], [16], and cerebritis [3], [17]. However, these findings have generally appeared as case reports or small case series.…”

Section: Introductionmentioning

confidence: 99%

Neurologic Manifestations Associated with an Outbreak of Typhoid Fever, Malawi - Mozambique, 2009: An Epidemiologic Investigation

et al. 2012

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BackgroundThe bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness.ObjectiveDescribe neurologic features complicating typhoid fever during an outbreak in Malawi-MozambiqueMethodsPersons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate.ResultsBetween March – November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs.ConclusionsNeurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas.

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“…Varied presentations of typhoid fever are known in the paediatric age group, such as septicemia in neonates, as diarrhoea in infants, and as lower respiratory tract infections in older children [11][12][13]. Atypical presentations in older children include splenic abscess, liver abscess, cerebellar ataxia, meningitis, cholecystitis, chorea, palatal palsy, osteomyelitis, peritonitis, aphasia and even psychosis [14][15][16][17][18][19][20][21][22]. Due to these varied and atypical presentations, it is common for typhoid fever in children to be diagnosed late or even remain unrecognised.…”

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Multidrug-resistant typhoid fever: a review

Zaki

Karande

2011

J Infect Dev Ctries

127

116

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Introduction: Multidrug-resistant typhoid fever (MDRTF) is defined as typhoid fever caused by Salmonella enterica serovar Typhi strains (S. Typhi), which are resistant to the first-line recommended drugs for treatment such as chloramphenicol, ampicillin and trimethoprimsulfamethoxazole. Since the mid-1980s, MDRTF has caused outbreaks in several countries in the developing world, resulting in increased morbidity and mortality, especially in affected children below five years of age and those who are malnourished. Methodology: Two methods were used to gather the information presented in this article. First PubMed was searched for English language references to published relevant articles. Secondly, chapters on typhoid fever in standard textbooks of paediatric infectious diseases and preventive and social medicine were reviewed. Results: Although there are no pathognomonic clinical features of MDRTF at the onset of the illness, high fever ( > 104°F), toxaemia, abdominal distension, abdominal tenderness, hepatomegaly and splenomegaly are often reported. The gold standard for the diagnosis of MDRTF is bacterial isolation of the organism in blood cultures. Ciprofloxacin and ceftriaxone are the drugs most commonly used for treatment of MDRTF and produce good clinical results. Conclusion: MDRTF remains a major public health problem, particularly in developing countries. Mass immunization in endemic areas with either the oral live attenuated Typhi 21a or the injectable unconjugated Vi typhoid vaccine, rational use of antibiotics, improvement in public sanitation facilities, availability of clean drinking water, promotion of safe food handling practices and public health education are vital in the prevention of MDRTF.

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Isolated cerebellar ataxia: an early neurological complication of enteric fever

Cited by 9 publications

References 11 publications

Salmonella Typhimurium Infection Leads to Colonization of the Mouse Brain and Is Not Completely Cured With Antibiotics

Salmonella Typhimurium Infection Leads to Colonization of the Mouse Brain and Is Not Completely Cured With Antibiotics

Neurologic Manifestations Associated with an Outbreak of Typhoid Fever, Malawi - Mozambique, 2009: An Epidemiologic Investigation

Multidrug-resistant typhoid fever: a review

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