Typhoid fever presenting as a depressive disorder--a case report.

CONTEXT: Neuropsychiatric complications associated with typhoid fever are relatively common in the tropics; however, typhoid fever with associated depression is rare and can present a diagnostic challenge to rural clinicians. ISSUE: This case report describes a 12 year old female with no documented psychiatric history who developed signs and symptoms of delirium with depressive elements while also infected with typhoid fever. At the time of presentation to a community health centre in Abeokuta, Nigeria, the patient had been misdiagnosed as suffering from primary psychiatric morbidity and therefore mismanaged. Following investigation and appropriate therapy she made a complete recovery. LESSONS LEARNED: A rural physician working in an area with an inadequate safe water supply can expect to encounter several cases of typhoid fever with neuropsychiatric presentation. In order to make a correct diagnosis clinicians must maintain a high index of suspicion of primary medical morbidity in patients presenting with depressive features associated with a febrile illness.