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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 4  |  Page : 433-435

Guillain-Barré syndrome as a complication of typhoid fever in a child


1 Department of Pediatrics, Lok Nayak Hospital, New Delhi, India
2 Department of Pediatrics, Maulana Azad Medical College, New Delhi, India

Date of Web Publication6-Sep-2012

Correspondence Address:
Sumit Mehndiratta
Department of Pediatrics, Lok Nayak Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.100722

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How to cite this article:
Mehndiratta S, Rajeshwari K, Dubey AP. Guillain-Barré syndrome as a complication of typhoid fever in a child. Neurol India 2012;60:433-5

How to cite this URL:
Mehndiratta S, Rajeshwari K, Dubey AP. Guillain-Barré syndrome as a complication of typhoid fever in a child. Neurol India [serial online] 2012 [cited 2021 Oct 21];60:433-5. Available from: https://www.neurologyindia.com/text.asp?2012/60/4/433/100722


Sir,

Guillain-Barrι syndrome (GBS) is a rare complication of typhoid fever and only a few such cases have been reported in the pediatric age group. [1],[2],[3],[4],[5]

A 2΍-year-old child presented with fever of 20 days duration, not responding to medications (cefixime) started after a blood culture growth of  Salmonella More Details typhi. The mother also noticed that the child had shown a reluctance to walk since 4 days before admission. On physical examination, child was febrile with a moderate degree of hepatosplenomegaly with pallor. Central nervous system examination was normal, except for reduced motor power (4/5) in both the lower limbs with hypoflexia. Investigations revealed: Hemoglobin of 6.1g%, total leuckocyte count of 6500/cmm (polymorphs 56%, lymphocytes 46%, monocytes 2%, and eosinophils 2%), and platelet count of 4,06,000 per ul. Blood culture showed no growth, but a Widal test showed TO titre of 1:160, TH titre of 1:160, AH titre of 1:80, and BH titer of 1:80. (normal value < 1:80). Ultrasonography of the abdomen revealed hepatosplenomegaly. Based on the Widal test, a diagnosis of typhoid fever was made, and the child was treated with injectable ceftriaxone. On day-2 of admission, there was worsening of power in both lower limbs (3/5) and deep tendon reflexes were not elicitable on the next day. CPK was normal. Suspecting a provisional diagnosis of GBS, cerebrospinal fluid (CSF) examination was done, which revealed 30 lymphocytes, protein of 234 mg/dl and sugar 65 mg/dl. Electrodiagnostic studies revealed demyelinating type of motor and sensory neuropathy [Table 1]. She was not given IVIg, because the general condition of the child started improving on supportive therapy. By day-10 of admission, the child was able to walk with support and the muscle power was 4/5 in lower limbs. A final diagnosis of typhoid fever complicated with GBS was established.
Table 1: NCV study of the patient

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The most common neurological complication of typhoid fever is encephalopathy. [6],[7] Other complications include: Meningitis, catatonia,  Parkinsonism More Details-like state, benign intracranial hypertension, cranial nerve palsies, cerebellar ataxia, and GBS, which are rare. [1],[2],[3],[4],[5],[8],[9] The exact pathogenesis of these complications is not known. It has been postulated that toxemia, along with metabolic disturbances and non-specific cerebral changes such as edema and hemorrhage, may be responsible for encephalopathy. [10] Other possibilities that have been suggested are hyperpyrexia, vasculitis, or autoimmune mechanisms. [4],[11] The typhoid endotoxin may effect any part of the central nervous system and may be the possible mechanism behind the wide spectrum of neurological complications of typhoid fever. [12] A non-T-cell-dependent mechanism of generation of IgM antibodies against some components of the bacterial capsule and their cross reactivity with myelin gangliosides has also been proposed for GBS in typhoid fever. [2] Unusual manifestations and neurological complications may sometimes be confounding factors in the diagnosis. Strict vigilance and a high index of suspicion are required to diagnose and treat these complications timely, which may otherwise have serious consequences.

 
  References Top

1.Datta V, Sahare P, Chaturved P. Guillain-Barre syndrome as a complication of enteric fever. J Indian Med Assoc 2004;102:172-3.  Back to cited text no. 1
[PUBMED]    
2.Aldrey JM, Fernández-Rial A, López-González FJ, Doval JC, de la Fuente-Fernández R. Guillain-Barré syndrome as first manifestation of typhoid fever. Clin Infect Dis 1999;28:1171-2.  Back to cited text no. 2
    
3.Ozen H, Cemeroðlu P, Ecevit Z, Seçmeer G, Kanra G. Unusual neurologic complications of typhoid fever (aphasia, mononeuritis multiplex, and Guillain-Barré syndrome): A report of two cases. Turk J Pediatr 1993;35:141-4.  Back to cited text no. 3
    
4.May W, Senitiri I. Guillain-Barré syndrome associated with typhoid fever. A case study in the Fiji Islands. Pac Health Dialog 2010;16:85-8.  Back to cited text no. 4
    
5.Berger JR, Ayyar DR, Kaszovitz B. Guillain-Barré syndrome complicating typhoid fever. Ann Neurol 1986;20:649-50.  Back to cited text no. 5
    
6.Sharma A, Gathwala G. Clinical profile and outcome in enteric fever. Indian Pediatr 1993;30:47-50.  Back to cited text no. 6
    
7.Osuntokun BD, Bademosi O, Ogunremi K, Wright SG. Neuropsychiatric manifestations of typhoid fever in 959 patients. Arch Neurol 1972;27:7- 13.  Back to cited text no. 7
    
8.Ali G, Rashid S, Kamli MA, Shah PA, Allaqaband GQ. Spectrum of neuropsychiatric complications in 791 cases of typhoid fever. Trop Med Int Health 1997;2:314-8.  Back to cited text no. 8
    
9.Biswal N. Neurological manifestations of typhoid fever in children. J Trop Pediatr 1994;40:190.  Back to cited text no. 9
    
10.Cohen JI, Bartlett JA, Corey GR. Extra-intestinal manifestations of salmonella infections. Medicine 1987;66:349-88.  Back to cited text no. 10
    
11.Haque A. Neurological manifestations of entericfever. In: Chopra JS, Sawhney IMS, editors. Neurologyin the Tropics. New Delhi: BI Churchill Livingstone; 1999. p. 506-12.  Back to cited text no. 11
    
12.Ghosh JB, Senapati S. Palatal palsy in enteric fever. Indian Pediatr 2005;32:106-7.  Back to cited text no. 12
    



 
 
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