ArticlePloS one2012
Neurologic manifestations associated with an outbreak of typhoid fever, Malawi--Mozambique, 2009: an epidemiologic investigation.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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23 citing papers in PubMed, 52 citations in OpenAlex.
- Evaluation of mdh, dld, tcfA, and folE gene markers for detection of enteric fever using real-time PCR.Scientific reports · 2026Article
- A case of typhoid fever with neurological presentation.IDCases · 2025Article
- Overview of management of infection-related movement disorders with focus on specific-infections.Clinical parkinsonism & related disorders · 2024Article
- A Critical Review of the Neuropharmacological Effects of Kratom: An Insight from the Functional Array of Identified Natural Compounds.Molecules (Basel, Switzerland) · 2023Review
- FromACS omega · 2023Review
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- Enteric Fever Diagnosis: Current Challenges and Future Directions.Pathogens (Basel, Switzerland) · 2021Review
- Salmonella Typhoid Toxin PltB Subunit and Its Non-typhoidal Salmonella Ortholog Confer Differential Host Adaptation and Virulence.Cell host & microbe · 2020Article
- The role of 9-O-acetylated glycan receptor moieties in the typhoid toxin binding and intoxication.PLoS pathogens · 2020Article
- Outbreak of acute undifferentiated febrile illness in Kathmandu, Nepal: clinical and epidemiological investigation.BMC infectious diseases · 2020Article
- Acute sensorineural hearing loss as atypical presentation of typhoid fever in adult patient.SAGE open medical case reports · 2020Article
- Mild Encephalopathy/Encephalitis with Reversible Splenial Lesion in a Patient withIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2019Article
- Ascertaining the burden of invasive Salmonella disease in hospitalised febrile children aged under four years in Blantyre, Malawi.PLoS neglected tropical diseases · 2019Article
- The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions.The American journal of tropical medicine and hygiene · 2018Article
- Why Is Eradicating Typhoid Fever So Challenging: Implications for Vaccine and Therapeutic Design.Vaccines · 2018Review
- In vivo tropism of Salmonella Typhi toxin to cells expressing a multiantennal glycan receptor.Nature microbiology · 2018Article
- The Role of Typhoid Toxin inThe Yale journal of biology and medicine · 2017Review
- The burden of typhoid fever in low- and middle-income countries: A meta-regression approach.PLoS neglected tropical diseases · 2017Article
- Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi.PLoS neglected tropical diseases · 2015Article
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Authors and funding
23 authors at 12 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness.
objectiveDescribe neurologic features complicating typhoid fever during an outbreak in Malawi-Mozambique
methodsPersons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate.
resultsBetween March - November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs.
conclusionsNeurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas.
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