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The "typhoid state" revisited.

A Verghese
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Abstract

The "typhoid state" occurs classically with typhoid and typhus fevers but is also seen in other infectious diseases. Clinical descriptions of this state as "muttering delirium" or "coma vigil" refer to the peculiar preoccupied nature of the stupor. Picking at the bedclothes and at imaginary objects (carphology and floccillation) are characteristic, as is muscular twitching (subsultus tendinum). There is strong evidence that the death of Falstaff in Shakespeare's Henry V is a vivid description of the typhoid state.

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DeliriumDramaFeverHistory, 16th CenturyHistory, 17th CenturyHumansMedicine in LiteratureMotor ActivityMuscle ContractionTyphoid FeverTyphus, Epidemic Louse-BorneBiographyHistorical ArticleJournal Article

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A Verghese. 1985. The "typhoid state" revisited.. https://doi.org/10.1016/0002-9343(85)90316-x

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Incidence, risk factors and consequences of ICU delirium.

OBJECTIVE: Delirium in the critically ill is reported in 11-80% of patients. We estimated the incidence of delirium using a validated scale in a large cohort of ICU patients and determined the associated risk factors and outcomes. DESIGN AND SETTING: Prospective study in a 16-bed medical-surgical intensive care unit (ICU). PATIENTS: 820 consecutive patients admitted to ICU for more than 24 h. INTERVENTIONS: Tools used were: the Intensive Care Delirium Screening Checklist for delirium, Richmond Agitation and Sedation Scale for sedation, and Numerical Rating Scale for pain. Risk factors were evaluated with univariate and multivariate analysis, and factors influencing mortality were determined using Cox regression. RESULTS: Delirium occurred in 31.8% of 764 patients. Risk of delirium was independently associated with a history of hypertension (OR 1.88, 95% CI 1.3-2.6), alcoholism (2.03, 1.2-3.2), and severity of illness (1.25, 1.03-1.07 per 5-point increment in APACHE II score) but not with age or corticosteroid use. Sedatives and analgesics increased the risk of delirium when used to induce coma (OR 3.2, 95% CI 1.5-6.8), and not otherwise. Delirium was linked to longer ICU stay (11.5+/-11.5 vs. 4.4+/-3.9 days), longer hospital stay (18.2+/-15.7 vs. 13.2+/-19.4 days), higher ICU mortality (19.7% vs. 10.3%), and higher hospital mortality (26.7% vs. 21.4%). CONCLUSION: Delirium is associated with a history of hypertension and alcoholism, higher APACHE II score, and with clinical effects of sedative and analgesic drugs.

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