A Case Series for Salmonella Carriers Who Presented with Psychosomatic Depressive Disorder and Showed Improvement after Ceftriaxone Treatment for 15 Days

Abstract

Background: Based on our observations, as physicians in a Referral Hospital, we have been noticing the association between history of enteric fever and somatic disorders associated with low mood. At our hospital, Al- Hussein University Hospital, Cairo, Egypt, we are receiving patients from all over Egypt, including rural areas where enteric fever is endemic. Here we report this series for 15 patients referred to us for evaluation of different somatic disorders. Clinical presentation: After extensive evaluations, the patients’ symptoms were proved to be functional, their typhoid carrier states were documented, they were evaluated for depression using Hamilton-D questionnaire and the severity of depression was recorded. All patients were treated by ceftriaxone, 2 g, IV, daily for 15 days. Clinical evaluation and Hamilton score were reassessed at the end of treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the Salmonella species not by serology, plus at least one occasion of Salmonella isolates from stool culture while afebrile, plus absence of fever in the past 3 weeks. The Widal test wasn’t accepted as a criterion for enrolment. Results: Patients showed clinically significant improvement in term of the presenting somatic complaints as well as their Hamilton-D score immediately post-treatment and consolidate for 6 weeks post-treatment completion. Conclusion: Typhoid carrier in our series was associated with psychosomatic depression that improved on antibiotic therapy.