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