Enteric fever

Dear Editor

Thanks for the article, however we would like to add that Enteric fever presenting with atypical manifestations is challenging even to astute clinicians and is not a new occurrence in the tropics. Some of them present as displaying toxic delirium, delusions of persecution, schizophrenia type symptoms, Mania symptoms leading them to get admitted under psychiatric evaluation initially and later being treated for Typhoid fever (1, 2,5).

Less commonly they can present with generalized anxiety disorder, depressive episode, and monosymptomatic neuropsychiatric manifestations such as apathy, hallucinations and irrelevant talking (3).

The importance of a high index of suspicion in the functional-type psychosis, that might be due to typhoid fever and the need to institute therapy for typhoid fever while investigating (the late appearing fever) in such cases are emphasized (4). Clinicians should be aware that the true diagnosis may be obscured by the psychiatric manifestations and the management of the case made more difficult.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923618/ Typhoid Fever Presenting as Acute Psychosis
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1589441/ psychiatric symptoms in typhoid fever
3. https://pubmed.ncbi.nlm.nih.gov/11427249/ Correlates of psychiatric morbidity in typhoid fever in a Nigerian general hospital setting
4. https://pubmed.ncbi.nlm.nih.gov/1790134/ Typhoid fever masquerading as functional psychosis
5. https://jamanetwork.com/journals/jamaneurology/article-abstract/571471 Neuropsychiatric Manifestations of Typhoid Fever in 959 Patients