Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Dr Zenilman1
is to be complimented both for reminding us of the importance of typhoid fever
as one cause of a febrile infection in a patient returning from India and
for his lucid, contemporary review of this severe systemic illness.
In the Grand Rounds at The Johns Hopkins Hospital presentation, therapy
for typhoid fever focused exclusively on antimicrobial treatment, however,
and omitted commentary regarding the administration of a glucocorticoid for
treatment of the patient with shock or altered mental status. Based on 1 randomized,
double-blind, placebo-controlled study, dexamethasone infusion was associated
with enhanced survival when this glucocorticoid was administered to severely
ill patients.2 This may be an exception
to the rule that glucocorticoid administration is not indicated for patients
with gram-negative sepsis or shock. Dexamethasone should be prescribed for
only 48 hours, as prolonged therapy may increase the risk of relapse.
Gleckman R. Emerging Drug Resistance and Vaccination for Typhoid Fever. JAMA. 1998;279(8):579-580. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-8-jbk0225