Complicated multi-drug resistant typhoid fever with cerebral oedema, diffuse encephalitis and fungal infection of the oral cavity: A case report.

Enteric fever is a highly fatal infectious disease that can present with extensive symptoms that renders diagnosis quite risky. Multi-drug resistant Salmonella typhi infection has become endemic in third world countries and has been routinely associated with catastrophic complications and even death, with diagnostic and therapeutic impedance. Typhoid fever is known to cause life-threatening cerebral complications. We report the case of a 16-year-old male who presented to us with a high-grade fever, watery diarrhoea, altered level of consciousness, and a mixed dark-coloured crusted oral lesion. Blood workup showed neutropenia, lymphocytopenia, thrombocytopenia, transaminitis, and hyponatraemia. Blood culture grew multi-drug resistant Salmonella Typhi. CT scan of the brain showed diffuse cerebral oedema, while EEG was consistent with the diagnosis of diffuse encephalitis. The patient responded well to culture-sensitive antibiotics, while the oral lesion showed a dramatic response to presumptive antifungal treatment. We discuss the compositions available to date on typhoid-associated encephalitis and the connection of fungal infection in this specific case attempting to promote awareness regarding possible unorthodox presentations of enteric fever.

Ritonavir-boosted Nirmatrelvir and COVID-19 outcomes in the age of Omicron variant.

Nirmatrelvir boosted with Ritonavir is the recommended and preferred treatment for COVID-19. Because real-world evidence of Nirmatrelvir's antiviral activity against the Omicron variation is minimal, our study focuses on recent papers suggesting the use of Ritonavir-boosted Nirmatrelvir in the real world against the most frequent SARS coronavirus variant circulating worldwide (Omicron). Despite sparse clinical evidence, we discovered that Ritonavir-boosted Nirmatrelvir reduced COVID-19-related hospitalization and mortality during the onset of the Omicron variant. Furthermore, this study discusses the main limitations and offers recommendations for administering this drug in non-hospitalized COVID-19 patients at high risk for severe infection.