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Enteric Encephalopathy Medicine Physiotherapy typhoid fever

Enteric Encephalopathy

In this article we will discuss Enteric Encephalopathy

In this article, we will discuss Enteric Encephalopathy. So, let’s get started.

Enteric Encephalopathy

It is a toxic complication, occurs commonly during second or third week of typhoid fever, is characterized by fever with an altered state of consciousness ranging from disorientation to coma and has a mortality rate exceeding 40%.

Treatment

It includes:

  • Care of semiconscious or unconscious state
  • Intravenous fluids to treat dehydration and to maintain proper hydration and blood pressure so as to prevent other complications. Vitals are to be monitored
  • Intravenous antibiotics specially third generation cephalosporin, e.g. ceftriaxone, 2g I.V 12 hourly for 2-3 days then 1g after every 12 hours over few days is highly effective
  • High dose corticosteroids: High dose corticosteroids has been recommended in this complication. High dose of corticosteroids in typhoid fever with CNS manifestations and/or evidence of DIC if given along with antibiotic therapy, reduces the mortality rate. Dexamethasone 3 mg/kg I.V as a bolus followed by 1 mg/kg I.V every 6 hours for 24-48 hours should be considered in such a typhoid state
  • If patient recovers, he/she has to be treated with one of the drugs used to treat carrier state. This is given for 4 weeks to sterilise the gall bladder and to prevent relapse and to eradicate the organisms to prevent carrier state.
  • Treatment of carriers: A person is said to be carrier if he/she excretes the organisms in the stool after 1 year following illness. Carrier state in the absence of gallstones is treated by oral ampicillin 100 mg/kg/day for 6 weeks or cotriamoxazole 960 mg/day for 4 weeks or Ciprofloxacin 750 mg bid for 4 weeks to sterilise the gallbladder which is responsible for this state. Cholecystectomy may be necessary in some cases.

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