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| LETTER TO EDITOR |
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| Year : 2012 | Volume
: 60
| Issue : 4 | Page : 433-435 |
Guillain-Barré syndrome as a complication of typhoid fever in a child
Sumit Mehndiratta1, Krishnan Rajeshwari2, Anand Prakash Dubey2
1 Department of Pediatrics, Lok Nayak Hospital, New Delhi, India
2 Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| Date of Web Publication | 6-Sep-2012 |
Correspondence Address:
Sumit Mehndiratta
Department of Pediatrics, Lok Nayak Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.100722
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 |
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.
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.
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[Table 1]
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