RESUMO
Over a 6-year period, we studied 791 patients with multidrug-resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo-encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo-encephalitis are associated with significant morbidity but very low mortality (0.5%).
Assuntos
Doenças Cerebelares/diagnóstico , Confusão/diagnóstico , Encefalite/diagnóstico , Meningoencefalite/diagnóstico , Mielite/diagnóstico , Doença de Parkinson/diagnóstico , Polimiosite/diagnóstico , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Febre Tifoide/complicações , Adolescente , Adulto , Antibacterianos/uso terapêutico , Doenças Cerebelares/complicações , Doenças Cerebelares/epidemiologia , Confusão/complicações , Confusão/epidemiologia , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Encefalite/complicações , Encefalite/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Meningoencefalite/complicações , Meningoencefalite/epidemiologia , Pessoa de Meia-Idade , Mielite/complicações , Mielite/epidemiologia , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Polimiosite/complicações , Polimiosite/epidemiologia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/epidemiologia , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Febre Tifoide/tratamento farmacológico , Febre Tifoide/epidemiologiaAssuntos
Cardiomiopatias/diagnóstico , Febre Reumática/diagnóstico , Infecções por Salmonella/diagnóstico , Salmonella typhi , Doença Aguda , Adolescente , Adulto , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Erros de Diagnóstico , Feminino , Humanos , Masculino , Infecções por Salmonella/complicaçõesRESUMO
Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.
Assuntos
Ruptura Esplênica/microbiologia , Febre Tifoide/complicações , Adolescente , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Salmonella typhi/efeitos dos fármacosRESUMO
We have evaluated the immediate heart rate response to standing and lying and in 100 Diabetic subjects aged 43 +/- 10 years who underwent five other cardiovascular autonomic tests. Using a specially devised scoring system the patients were divided into three groups: a) 58 subjects without autonomic neuropathy, b) 15 borderliners, c) 27 with autonomic neuropathy. The results were compared with 50, sex and age matched controls. We studied SL1 = ratio between R-R mean before lying and R-R maximum between the 20th to 25th beat and R-R minimum over the first 5 beats after lying. In controls SL1 was 1.35 +/- 0.18 and SL2 was 1.52 +/- 0.23. In diabetic subjects without autonomic neuropathy SL1 was 1.20 +/- 0.86 (p < 0.01), SL2 1.50 +/- 0.02 (p < 0.001). In the group with autonomic neuropathy SL1 was 1.04 +/- 0.02 (p < 0.001) and SL2 was 1.20 +/- 0.09 (p < 0.001). We propose that the lowest normal and highest abnormal limits of SL1 are 1.12 and 1.08 respectively and that normal and highest abnormal limits of SL2 are 1.23 and 1.18 respectively. We suggest the use of SL1 as a pure parasympathetic test and SL2 as a mixed but predominantly sympathetic test in the diagnosis of autonomic neuropathy.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Neuropatias Diabéticas/diagnóstico , Movimento , Postura , Adolescente , Adulto , Idoso , Feminino , Coração/inervação , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report the first ever report of multiple drug resistant salmonella typhi epidemic from Asia. The outbreak started in April 1988 and virtually ended by June 1988. The outbreak occurred in Baramullah town of Kashmir valley. In an epidemiological survey 230 cases were diagnosed as enteric fever. 46 cases (20%) were culture positive. A very rare multiple drug resistant strain of S. typhi was identified as phage type biotype II untypeable (UVS2). The strain was sensitive to Norfloxacin. This outbreak of S. typhi has many similarities with Mexico epidemic. Ingestion of contaminated water seems to be the possible cause for the outbreak.
Assuntos
Países em Desenvolvimento , Surtos de Doenças , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/epidemiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Feminino , Humanos , Lactente , Masculino , Febre Tifoide/tratamento farmacológicoRESUMO
Various neuropsychiatric syndromes in typhoid fever were seen in nine patients of multiple drug resistant (both in vitro and in vivo) Salmonella typhi infection of a total of 270 suspected cases in the last two years. All but one patient received oral norfloxacin (400 mg 12 hourly) for two weeks with complete recovery, while the other patient died. Bacteremia and toxemia seem to be the only common factor responsible for neuropsychiatric complications.
