Factors Associated with Encephalopathy in Patients with Salmonella enterica Serotype Typhi Bacteremia Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Daniel T. Leung Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Jori Bogetz Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Megumi Itoh Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Lakshmi Ganapathi Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Mark A. C. Pietroni Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Edward T. Ryan Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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Mohammod Jobayer Chisti Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Children's Hospital Boston, Boston, Massachusetts; Dhaka Hospital and Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

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To characterize clinical correlates of typhoid fever-associated encephalopathy, we performed a retrospective chart review of patients with Salmonella enterica serotype Typhi bacteremia who were hospitalized at the International Centre for Diarrhoeal Disease Research, Bangladesh, from February of 2009 to June of 2011. Of 207 patients bacteremic with Salmonella Typhi who were ≥ 5 years of age, we identified 43 (21%) patients with encephalopathy. Univariate analysis revealed that patients with encephalopathy more often presented at ages of 10–24 years and had severe dehydration, low oxygen saturation, high respiratory rate, low leukocyte count, low platelet count, and Widal flagellar H agglutinin (TH) titer ≥ 1:640 compared with typhoid patients without encephalopathy. Multivariate analysis using logistic regression showed that age, dehydration, leukocyte count, and Widal TH titer were independently associated with encephalopathy. Our findings suggest that age, severity of disease, and immune responses are associated with encephalopathy during Salmonella Typhi bacteremia, perhaps reflecting the impact of prominent inflammatory responses.

Author Notes

*Address correspondence to Daniel T. Leung, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St., Jackson 504, Boston, MA 02114. E-mail: dleung@partners.org
†These authors contributed equally.
‡These authors are co-senior authors.

Authors' addresses: Daniel T. Leung and Edward T. Ryan, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, E-mails: dleung@partners.org and etryan@partners.org. Jori Bogetz and Megumi Itoh, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, E-mails: jbogetz@stanford.edu and mitoh@stanford.edu. Lakshmi Ganapathi, Department of Pediatrics, Children's Hospital Boston, Boston, MA, E-mail: Lakshmi.Ganapathi@childrens.harvard.edu. Mark A. C. Pietroni and Mohammod Jobayer Chisti, Dhaka Hospital and Centre for Nutrition and Food Security, Intensive Care Unit and Respiratory Ward, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh, E-mails: markp@icddrb.org and chisti@icddrb.org.

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