Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2012;7(12):e46099. doi: 10.1371/journal.pone.0046099. Epub 2012 Dec 3.
The 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.
Describe neurologic features complicating typhoid fever during an outbreak in Malawi-Mozambique
Persons 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.
Between 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.
Neurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas.
肠伤寒沙门氏菌血清型 Typhi 引起伤寒，通常伴有发热和腹痛。2009 年在马拉维和莫桑比克爆发的伤寒疫情中，神经系统疾病的比例很高。
描述马拉维和莫桑比克伤寒疫情中并发的神经系统表现。
通过监测确定符合临床病例定义的人，通过抗体检测或血液/粪便培养来确认伤寒。我们收集了人口统计学和临床信息，对患者进行了检查，并在发病后 11 个月对部分患者进行了评估。对有和没有神经系统体征的患者进行了维生素 B6 和 B12 水平以及尿硫氰酸盐检测。
2009 年 3 月至 11 月期间，共发现 303 例伤寒病例。40 人（13%）有客观的神经系统发现，其中 14 人通过培养/血清学证实；27 人（68%）住院，5 人（13%）死亡。17 人（43%）出现上运动神经元表现，包括反射亢进、痉挛或持续踝阵挛。其他神经系统表现包括共济失调（22，55%）、帕金森病（8，20%）和震颤（4，10%）。3 名（年龄分别为 5、7 和 18 岁）患者的脑部 MRI 显示脑萎缩，但无其他异常。13 名在发病后 11 个月再次评估的患者中，11 人完全康复，2 人仍有反射亢进和共济失调。有和没有神经系统体征的伤寒患者维生素 B6 水平均明显降低。
神经系统体征可能并发伤寒，在流行地区急性发热性神经系统疾病患者中应考虑诊断。
