780. Factors associated with encephalopathy in patients with Salmonella enterica serotype Typhi bacteremia in Dhaka, Bangladesh
Session: Oral Abstract Session: Travel/Tropical Medicine and Parasitology
Friday, October 21, 2011: 3:00 PM
Room: 204AB
Background: Typhoid fever is a major cause of morbidity and mortality in many developing countries. Encephalopathy is one of the life-threatening extra-intestinal complications of typhoid fever, featuring various neuropsychiatric manifestations including disorientation, altered consciousness, and psychosis. Mortality rates of up to 50% have been reported. There are limited data on the pathogenesis and risk factors associated with typhoid encephalopathy. 

Methods: We performed a retrospective chart review of patients with Salmonella enterica serotype Typhi bacteremia who were admitted to the ICDDR,B Dhaka Hospital from February 2009 to March 2011. Out of 185 patients bacteremic with S. Typhi who were ≥ 5 years of age, we identified 24 cases of patients with encephalopathy, defined as documentation of Glasgow Coma Scale of < 15 and/or disorientation on exam. We compared these cases to 96 randomly selected controls ≥ 5 years of age with S. Typhi bacteremia and no evidence of encephalopathy.

Results: Univariate analysis revealed that patients with encephalopathy more often presented at adolescent age (13-20 years, P=0.001), more often had severe dehydration (P<0.001), low oxygen saturation (P<0.001), low leukocyte count (P=0.03), and Widal TH titer ≥1:320 (P=0.02) compared to typhoid patients without encephalopathy. Neither the magnitude nor duration of fever, antibiotic resistance pattern, nor use of pre-admission antibiotics were related to encephalopathy. In multivariate analysis using logistic regression, only severe dehydration [odds ratio (OR) = 14, 95% confidence interval (CI): 2, 98; P=0.006] and low oxygen saturation (OR = 0.6, 95% CI: 0.4-0.9; P=0.01) were significant factors independently associated with encephalopathy.

Conclusion: Several of the risk factors identified in this retrospective study, such as severe dehydration, low oxygen saturation, and low leukocyte count, are likely a reflection of the severity of disease, and underscore the importance of prompt recognition and treatment of S. Typhi bacteremia. The association of adolescent age with typhoid encephalopathy deserves further investigation.


Subject Category: T. Travel/tropical medicine and parasitology

Daniel Leung, MD, MSc1,2,3, Jori Bogetz, MD4, Megumi Itoh, MD4, Mark Pietroni, MA, MBBChir, FRCP, DTM&H3, Edward T. Ryan, MD, DTMH, FIDSA1,2 and Mohammod Jobayer Chisti, MBBS, MMed3, (1)Infectious Diseases, Massachusetts General Hospital, Boston, MA, (2)Medicine, Harvard Medical School, Boston, MA, (3)International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh, (4)Lucile Packard Children's Hospital, Palo Alto, CA

Disclosures:

D. Leung, None

J. Bogetz, None

M. Itoh, None

M. Pietroni, None

E. T. Ryan, None

M. J. Chisti, ICDDR,B: Scientific Advisor, Research support

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