Control and Prevention of HIV/AIDS, STDs & STIs

Background: Typhoid fever remains to be an important cause of life threatening illness in the developing world. Neuropsychiatric manifestations of Salmonella infection have been described in case reports and case series. Infection with the HIV is a rising epidemic worldwide. Its presence can lead to altered clinical presentation of disease among patients.

 

Case presentation: We report a case of a 32 year-old Filipino male who developed acute onset febrile illness, with temperatures ranging from 38-39ºC associated with acute psychosis. He was admitted to our hospital on June 25, 2015 on his fourth day of illness. The patient was received awake, disoriented to person, place and time. He had a BP of 110/70 mmHg, regular pulse rate

of 112 and temperature of 38.6ºC. The physical examination only showed oral thrush, seborrheic dermatitis on the face and scalp. There were no abdominal tenderness, hepatomegaly generalized rash and focal neurologic deficit. The patient had supple neck. The initial assessment was bacterial and viral meningitis and septic encephalopathy. Laboratory investigations showed

anemia with a normal leukocyte count, elevated creatinine at 141 mol/L. The chest X-ray and urinalysis showed no infection. Cranial CT scan and cerebrospinal fluid studies were normal. The patient tested positive in the HIV confirmatory test. He was empirically treated with ceftriaxone 2 gm IV 12 hourly and acyclovir 700 mg IV 8 hourly. On the fourth hospital day, the blood

culture revealed Salmonella typhi sensitive to ceftriaxone. Acyclovir was discontinued and the ceftriaxone was reduced to nonmeningitis dose. The patient defervesced on day four of ceftriaxone and had improved sensorium on day six of antibiotics. The patient was discharged improved.

 

Discussion: We present a case of typhoid fever presenting as acute psychosis in a HIV patient. Salmonella infection remains a common the developing world. The mechanism by which it causes neuropsychiatric disorder is not yet known. In the time of HIV epidemic, diseases may have an altered spectrum of presentation. Physicians should keep in mind the full spectrum of disease manifestations and a high index of suspicion in order to arrive at the proper diagnosis and management.