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Ali KN, Shareef FO, Abdul Aziz JM, Najmadden ZB, Karim AH. Infant Salmonella enterica Meningitis: A Rare Case Report and Review of Literature. Cureus 2024; 16:e55405. [PMID: 38562346 PMCID: PMC10984613 DOI: 10.7759/cureus.55405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Meningitis caused by Salmonella enterica can be a fatal condition that is more common in low- and middle-income countries and uncommon in infants. This case of a 2-month-old male infant reported Salmonella meningitis symptoms, such as fever, irritability, altered sensorium, and diarrhoea. Clinical examination revealed bulging anterior fontanelles, dehydration, and sunken eyes. Screening for normal hearing, cranial ultrasound, and magnetic resonance imaging (MRI) revealed no brain abnormalities. A cerebrospinal fluid (CSF) culture revealed gram-negative Salmonella enterica bacilli. Treatment with meropenem and ampicillin was initiated after antibiotic susceptibility testing showed sensitivity. The patient's cerebrospinal fluid parameters and bacterial growth improved after antibiotic therapy. Two weeks later, the baby was neurologically healthy and discharged. Paediatricians should be aware that Salmonella enterica can cause meningitis in children with non-specific symptoms.
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Affiliation(s)
- Khalid N Ali
- Biomedical Sciences, Komar University of Science and Technology, Sulaymaniyah, IRQ
| | - Farman O Shareef
- Medical Laboratory Science, Charmo University, Sulaymaniyah, IRQ
| | - Jeza M Abdul Aziz
- Biomedical Sciences, Komar University of Science and Technology, Sulaymaniyah, IRQ
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | | | - Ari H Karim
- Baxshin Research center, Baxshin Hospital, Sulaymaniyah, IRQ
- Nursing, Azmar Technical and Vocational Institute, Sulaymaniyah, IRQ
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2
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Ullah R, Ahmad A, Salcedo YE, Hassan A, Khanal A, Chaulagain A. Concomitant Salmonella and Leptospira Meningitis: A Rare Case Report. Cureus 2024; 16:e54611. [PMID: 38524012 PMCID: PMC10959034 DOI: 10.7759/cureus.54611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
This study presents a unique case of concurrent salmonella and Leptospira meningitis in a 20-year-old woman with no prior medical history. Coinfection with endemic pathogens is plausible, especially in regions like Pakistan. While Salmonella meningitis is uncommon, it presents a significant medical emergency, particularly in immunocompromised adults. Neuroleptospirosis, though rare, can manifest in certain cases. The patient displayed persistent high fever, confusion, irritability, and a single seizure episode. Initial tests, including blood and cerebrospinal fluid (CSF) cultures and serological examinations, detected Salmonella typhi and positive leptospiral antibodies, respectively. Leptomeningeal enhancement was confirmed by an MRI. Treatment with azithromycin, meropenem, and ceftriaxone led to improvement after seven days. She was advised to complete a 28-day course for Salmonella meningitis. This case emphasizes the importance of considering multiple infectious causes, especially in endemic regions. Timely and thorough diagnostic evaluation, followed by appropriate antimicrobial therapy, is essential for effective management. Further research is warranted to enhance understanding of the epidemiology, clinical features, and optimal treatment strategies for such dual infections.
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Affiliation(s)
- Rizwan Ullah
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Aftab Ahmad
- Geriatrics, Cork University Hospital, Cork, IRL
| | | | - Amir Hassan
- Emergency Medicine, Bronglais General Hospital, Aberystwyth, GBR
| | - Anuva Khanal
- Internal Medicine, Shaheed Ziaur Rahman Medical College and Hospital, Bogra, BGD
| | - Aayush Chaulagain
- Internal Medicine, Shaheed Ziaur Rahman Medical College and Hospital, Bogra, BGD
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3
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Majeed I, Khan SU, Khan ZR, Hayat S, Ullah I, Ali A. Salmonella meningitis in a young child from Pakistan: a case report. J Med Case Rep 2023; 17:390. [PMID: 37705001 PMCID: PMC10500717 DOI: 10.1186/s13256-023-04128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting infants, children, and immunocompromised individuals. CASE PRESENTATION We present a case of a two-and-a-half-year-old Asian boy who developed Salmonella meningitis along with pneumonia and respiratory failure. Initially, he experienced symptoms of loose motions, fever, and irritability, which progressed to neck stiffness and brisk reflexes. Cerebrospinal fluid (CSF) analysis confirmed Salmonella typhi in the CSF. Due to the worsening condition, the patient was admitted to the intensive care unit, intubated, and switched to meropenem as the antibiotic of choice after an initial empiric therapy with ceftriaxone and vancomycin. With appropriate treatment, the patient showed significant improvement, including resolution of fever and respiratory symptoms. CONCLUSION Management of Salmonella meningitis is often challenging primarily because of the fact that the empiric therapy for meningitis may not always provide coverage to the multi-drug resistant Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on sensitivity testing is crucial for successful management. This case emphasizes the importance of early recognition and effective management of this uncommon yet severe complication of Salmonella infection.
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Affiliation(s)
| | | | | | | | | | - Asim Ali
- Lady Reading Hospital, Peshawar, Pakistan
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4
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Russotto Y, Micali C, Pellicanò GF, Nunnari G, Venanzi Rullo E. HIV and Mediterranean Zoonoses: A Review of the Literature. Infect Dis Rep 2022; 14:694-709. [PMID: 36136825 PMCID: PMC9498920 DOI: 10.3390/idr14050075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
A zoonosis is an infectious disease that has jumped from a non-human animal to humans. Some zoonoses are very common in the Mediterranean area and endemic in specific regions, so they represent an important problem for public health. Human Immunodeficiency Virus (HIV) is a virus that has originated as a zoonosis and is now diffused globally, with the most significant numbers of infected people among the infectious diseases. Since the introduction of antiretroviral therapy (ART), the history for people living with HIV (PLWH) has changed drastically, and many diseases are now no different in epidemiology and prognosis as they are in not-HIV-infected people. Still, the underlying inflammatory state that is correlated with HIV and other alterations related to the infection itself can be a risk factor when infected with other bacteria, parasites or viruses. We reviewed the literature for infection by the most common Mediterranean zoonoses, such as Campylobacter, Salmonella, Brucella, Rickettsia, Borrelia, Listeria and Echinococcus, and a possible correlation with HIV. We included Monkeypox, since the outbreak of cases is becoming a concern lately. We found that HIV may be related with alterations of the microbiome, as for campylobacteriosis, and that there are some zoonoses with a significant prevalence in PLWH, as for salmonellosis.
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Affiliation(s)
- Ylenia Russotto
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Cristina Micali
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age “G. Barresi”, University of Messina, 98124 Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
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Ahmed T, Ahmed T. Salmonella Meningitis Complicated by Ventriculitis and Brain Abscesses in an HIV Positive Adult Patient. Cureus 2020; 12:e11223. [PMID: 33269151 PMCID: PMC7704162 DOI: 10.7759/cureus.11223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Salmonella meningitis is a rare complication of Salmonella sepsis and is mostly reported in infants and young children. The incidence of Salmonella bacteremia is increased in immunocompromised adult individuals, such as those having human immunodeficiency virus (HIV) infection. Ventriculitis and brain abscess as a complication of Salmonella intracranial infection is particularly rare, even in patients who are immunosuppressed. Herein, we report a case of Salmonella meningitis complicated by ventriculitis and two brain abscesses in an HIV positive adult patient requiring mini-craniectomy and drainage along with a prolonged course of antibiotic therapy with a favorable outcome.
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Nadeem R, Elahi N, Elhoufi A, Elsousi A, Chaudhry M. Salmonella typhi Meningitis in an Immunocompetent Asian Adult. Cureus 2019; 11:e6112. [PMID: 31886051 PMCID: PMC6903881 DOI: 10.7759/cureus.6112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Enteric salmonella infections are common in the United States though nonenteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with meningitis signs and symptoms of >72 h duration like aseptic meningitis. A 25-year-old Indian male, without any past medical history brought by friends to the ER had fever and irritability for a week. He became increasingly somnolent and confused three days back. Physical exam reveals signs of meningitis and laboratory showed cerebrospinal fluid (CSF) studies suggestive of bacterial meningitis. Culture of CSF grew Salmonella typhi and later on blood culture also grew S. typhi. The patient became worse with cerebral edema and hydrocephalous suspected by change in neurological status and confirmed by ultrasound of eye ball examining optic nerve sheath diameter and CT scan of brain. The patient required neurosurgical intervention and hence external ventricular drain was placed. The patient was also placed on mechanical ventilation. Subsequently he developed ventilator associated pneumonia (VAP) with carbapenem-resistant Pseudomonas aeruginosa. The patient underwent tracheostomy and successfully completed treatment of VAP and was transferred to his home country after four months. Thus we describe a rare case of salmonella meningitis in an immunocompetent adult.
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Affiliation(s)
| | - Naheed Elahi
- Intensive Care Medicine, Dubai Hospital, Dubai, ARE
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7
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The Risk of Immunosuppression: A Case of Salmonella Meningitis. Case Rep Infect Dis 2018; 2018:4874575. [PMID: 29951326 PMCID: PMC5987290 DOI: 10.1155/2018/4874575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/10/2018] [Accepted: 05/10/2018] [Indexed: 11/19/2022] Open
Abstract
Salmonella meningitis is a rare infection, particularly in adults. We report the case of a 75-year-old female with a history of rheumatoid arthritis on TNF-antagonist immunosuppressive therapy who initially presented to the hospital for management of back and leg pain and was ultimately diagnosed with bacterial meningitis secondary to Salmonella species infection. She was treated with ceftriaxone with slow improvement in neurological function. Though the source of infection was never clearly identified from multiple imaging studies, we suspect the severity of her presentation was due to her history of TNF-antagonist use.
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8
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New Diagnosis of AIDS Based on Salmonella enterica subsp. I ( enterica) Enteritidis (A) Meningitis in a Previously Immunocompetent Adult in the United States. Case Rep Infect Dis 2017; 2017:1051975. [PMID: 28890836 PMCID: PMC5584356 DOI: 10.1155/2017/1051975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022] Open
Abstract
Salmonella meningitis is a rare manifestation of meningitis typically presenting in neonates and the elderly. This infection typically associates with foodborne outbreaks in developing nations and AIDS-endemic regions. We report a case of a 19-year-old male presenting with altered mental status after 3-day absence from work at a Wisconsin tourist area. He was febrile, tachycardic, and tachypneic with a GCS of 8. The patient was intubated and a presumptive diagnosis of meningitis was made. Treatment was initiated with ceftriaxone, vancomycin, acyclovir, dexamethasone, and fluid resuscitation. A lumbar puncture showed cloudy CSF with Gram negative rods. He was admitted to the ICU. CSF culture confirmed Salmonella enterica subsp. I (enterica) Enteritidis (A). Based on this finding, a 4th-generation HIV antibody/p24 antigen test was sent. When this returned positive, a CD4 count was obtained and showed 3 cells/mm3, confirming AIDS. The patient ultimately received 38 days of ceftriaxone, was placed on elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya) for HIV/AIDS, and was discharged neurologically intact after a 44-day admission.
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9
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Abstract
This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.
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10
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Keddy KH, Sooka A, Musekiwa A, Smith AM, Ismail H, Tau NP, Crowther-Gibson P, Angulo FJ, Klugman KP. Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013. Clin Infect Dis 2016; 61 Suppl 4:S272-82. [PMID: 26449942 DOI: 10.1093/cid/civ685] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. METHODS From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. RESULTS Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P = .039).Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P < .001). CONCLUSIONS NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.
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Affiliation(s)
- Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Arvinda Sooka
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Alfred Musekiwa
- International Emerging Infections Programme, South Africa Global Disease Detection Centre, Centers for Disease Control and Prevention, Pretoria
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Husna Ismail
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Nomsa P Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Penny Crowther-Gibson
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Frederick J Angulo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention
| | - Keith P Klugman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
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11
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Dworkin MS, Peterson CE, Gao W, Mayor A, Hunter R, Negron E, Fleury A, Besch CL. Efficacy of a food safety comic book on knowledge and self-reported behavior for persons living with AIDS. PLoS One 2013; 8:e72874. [PMID: 24124447 PMCID: PMC3790879 DOI: 10.1371/journal.pone.0072874] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/13/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Persons living with AIDS are highly vulnerable to foodborne enteric infections with the potential for substantial morbidity and mortality. Educational materials about foodborne enteric infections intended for this immunocompromised population have not been assessed for their efficacy in improving knowledge or encouraging behavior change. METHODS/RESULTS AIDS patients in four healthcare facilities in Chicago, New Orleans, and Puerto Rico were recruited using fliers and word of mouth to healthcare providers. Those who contacted research staff were interviewed to determine food safety knowledge gaps and risky behaviors. A food safety educational comic book that targeted knowledge gaps was created, piloted, and provided to these patients who were instructed to read it and return at least 2 weeks later for a follow-up interview. The overall food safety score was determined by the number of the 26 knowledge/belief/behavior questions from the survey answered correctly. Among 150 patients who participated in both the baseline and follow-up questionnaire, the intervention resulted in a substantial increase in the food safety score (baseline 59%, post-intervention 81%, p<0.001). The intervention produced a significant increase in all the food safety knowledge, belief, and behavior items that comprised the food safety score. Many of these increases were from baseline knowledge below 80 percent to well above 90%. Most (85%) of the patients stated they made a change to their behavior since receiving the educational booklet. CONCLUSION This comic book format intervention to educate persons living with AIDS was highly effective. Future studies should examine to what extent long-term behavioral changes result.
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Affiliation(s)
- Mark S. Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois, United States of America
- * E-mail:
| | - Caryn E. Peterson
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois, United States of America
| | - Weihua Gao
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Angel Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Hospital Universitario Ramón Ruiz Arnau, Santa Juanita, Bayamón, Puerto Rico, United States of America
| | - Robert Hunter
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Hospital Universitario Ramón Ruiz Arnau, Santa Juanita, Bayamón, Puerto Rico, United States of America
| | - Edna Negron
- Food Science and Technology Program, University of Puerto Rico-Mayagüez, Mayagüez, Puerto Rico, United States of America
| | - Alison Fleury
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - C. Lynn Besch
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
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Lund BM, O'Brien SJ. The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathog Dis 2011; 8:961-73. [PMID: 21561383 PMCID: PMC3159107 DOI: 10.1089/fpd.2011.0860] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In developed countries, such as the United Kingdom and the United States, between 15% and 20% of the population show greater susceptibility than the general population to foodborne disease. This proportion includes people with primary immunodeficiency, patients treated with radiation or with immunosuppressive drugs for cancer and diseases of the immune system, those with acquired immune-deficiency syndrome and diabetics, people suffering from liver or kidney disease or with excessive iron in the blood, pregnant women, infants, and the elderly. Malnutrition and use of antacids, particularly proton-pump inhibitors, also increase susceptibility. We review the occurrence of infection by foodborne pathogens in these groups of people and measures to prevent infection. The nature and use of low microbial diets to reduce the risk of foodborne disease in immunocompromised patients are very variable. Diets for vulnerable people in care should exclude higher-risk foods, and vulnerable people in the community should receive clear advice about food safety, in particular avoidance of higher-risk foods and substitution of safer, nutritious foods.
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13
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Belloso WH, Romano M, Greco GS, Davey RT, Perelsztein AG, Sánchez ML, Ajzenszlos MR, Otegui IM. Recurrent Meningitis and Subarachnoid Hemorrhage Due to Salmonella in an HIV+ Patient: Case Report and Mini-Review of the Literature. Open AIDS J 2011; 5:62-6. [PMID: 21772932 PMCID: PMC3139252 DOI: 10.2174/1874613601105010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/07/2011] [Accepted: 04/07/2011] [Indexed: 11/30/2022] Open
Abstract
Meningitis due to non-typhi salmonella is infrequent in HIV-positive adults. We report a case of a patient with >300 CD4+ cells/mm3 who presented with five episodes of recurrent meningitis, focal subarachnoid hemorrhage and cerebral vasculitis ultimately attributed to Salmonella choleraesuis infection. Even within the cART era invasive salmonellosis can occur in unusual ways in HIV-infected patients.
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Affiliation(s)
- Waldo H Belloso
- Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina
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14
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Hachfi W, Bellazreg F, Ladib M, Kaabia N, Khalifa M, Krifa H, Letaief A. Salmonella typhimurium epidural empyema in an HIV-infected patient. Infect Dis Rep 2009; 1:e5. [PMID: 24470883 PMCID: PMC3892569 DOI: 10.4081/idr.2009.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/01/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022] Open
Abstract
Salmonella focal intracranial infections are reported rarely. They tend to occur in immunocompromised patients. We present here a case of Salmonella typhimurium epidural empyema, with osteomyelitis of the adjacent frontal bone, in a 37-year-old human immunodeficiency virus positive man who presented with a three-day history of headache, fever, and sweats. He was treated successfully with antibiotics and surgical drainage.
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Affiliation(s)
- Wissem Hachfi
- Department of Infectious Diseases, and Internal Medicine, Farhat Hached University Hospital
| | - Foued Bellazreg
- Department of Infectious Diseases, and Internal Medicine, Farhat Hached University Hospital
| | - Mohamed Ladib
- Department of Neurosurgery, Sahloul University Hospital, Sousse, Tunisia
| | - Naoufel Kaabia
- Department of Infectious Diseases, and Internal Medicine, Farhat Hached University Hospital
| | - Mabrouk Khalifa
- Department of Infectious Diseases, and Internal Medicine, Farhat Hached University Hospital
| | - Hedi Krifa
- Department of Neurosurgery, Sahloul University Hospital, Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Diseases, and Internal Medicine, Farhat Hached University Hospital
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15
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Vaughn S, Pearce DD. A case report of recurrent Salmonella meningitis in an adult AIDS patient in the United States. ACTA ACUST UNITED AC 2008; 7:220-2. [PMID: 18812594 DOI: 10.1177/1545109708323130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors present a case of Salmonella sepsis and meningitis with a recurrence of the meningitis in a 36-year-old Hispanic, male AIDS patient. They discuss the mechanisms and routes in general and speculate on these items in this patient from the information available. Meningitis diagnosis and treatment in general and specifically in Salmonella cases are reviewed as well as the variations in AIDS patients. The probable reasons for the recurrence and etiology are discussed.
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16
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Carr BG, Weisbein JL, Gaieski DF. Salmonella meningitis in an immunocompetent adult. J Emerg Med 2008; 40:267-70. [PMID: 18534805 DOI: 10.1016/j.jemermed.2007.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 07/17/2007] [Accepted: 11/04/2007] [Indexed: 11/28/2022]
Abstract
Non-enteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with classic meningitis signs and symptoms of > 72 h duration. The objective of this work is to describe a rare case of salmonella meningitis in an immunocompetent adult and, in the context of previously published case reports, describe the frequently atypical clinical course of salmonella meningitis along with the potential pitfalls encountered during its evaluation and treatment. An otherwise healthy 45-year-old man presented to our Emergency Department with frontal headache, fever, and stiff neck of 7 days duration. He was alert and oriented in triage, where he was noted to be afebrile, mildly tachycardic, with a normal blood pressure and respiratory rate; shortly after triage he developed a high fever, severe tachycardia, hypotension, and a change in mental status. He was resuscitated according to our severe sepsis protocol and treated empirically for bacterial meningitis. Blood and cerebrospinal fluid cultures grew group D Salmonella berta. An evaluation for underlying immunodeficiency was unrevealing. The patient was discharged home on hospital day 7 in good condition. Salmonella meningitis can present with an indolent course and can mimic, in many misleading ways, the less serious diagnosis of aseptic meningitis. This case highlights the need for an unbiased clinical assessment, aggressive management of critical illness, and point-for-point correspondence between clinical data and assigned diagnosis.
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Affiliation(s)
- Brendan G Carr
- Department of Emergency Medicine, The Robert Wood Johnson Clinical Scholars Program, Princeton, New Jersey, USA
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Katsenos C, Anastasopoulos N, Patrani M, Mandragos C. Salmonella enteritidis meningitis in a first time diagnosed AIDS patient: case report. CASES JOURNAL 2008; 1:5. [PMID: 18577242 PMCID: PMC2438310 DOI: 10.1186/1757-1626-1-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 05/12/2008] [Indexed: 11/15/2022]
Abstract
We describe a patient with salmonella enteritidis meningitis and unknown HIV infection. Setting: A 14-bed adult intensive care unit in a tertiary hospital. The patient was brought to the emergency department with fever, nuchal rigidity and confusion. A first cerebrospinal fluid examination was non diagnostic. After a short period of improvement the patient developed septic shock. A second cerebrospinal fluid specimen was purulent. Both specimens yielded salmonella enteritidis and a blood culture as well. An Eliza reaction was performed and showed positive for HIV. The CD4(+) cells count was 16/mm3. The patient died with refractory shock eight days after admission in the intensive care unit.
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Affiliation(s)
- Chrisostomos Katsenos
- Red Cross Hospital of Athens Korgialeneio-Benakeio, Intensive Care Unit, Athanasaki 1 str, Ampelokipoi 11526 Athens, Greece.
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18
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Oral infection of mice with Salmonella enterica serovar Typhimurium causes meningitis and infection of the brain. BMC Infect Dis 2007; 7:65. [PMID: 17597539 PMCID: PMC1925087 DOI: 10.1186/1471-2334-7-65] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 06/27/2007] [Indexed: 11/22/2022] Open
Abstract
Background Salmonella meningitis is a rare and serious infection of the central nervous system following acute Salmonella enterica sepsis. For this pathogen, no appropriate model has been reported in which to examine infection kinetics and natural dissemination to the brain. Methods Five mouse lines including C57BL/6, Balb/c, 129S6-Slc11a1tm1Mcg, 129S1/SvImJ, B6.129-Inpp5dtm1Rkh were used in the murine typhoid model to examine the dissemination of systemic Salmonella enterica serovar Typhimurium following oral infection. Results We report data on spontaneous meningitis and brain infection following oral infection of mice with Salmonella enterica serovar Typhimurium. Conclusion This model may provide a system in which dissemination of bacteria through the central nervous system and the influence of host and bacterial genetics can be queried.
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Zagvazdina I, Zagvazdin Y, Willis GE, Gonzalez JH, Lesser W, Dickinson GM. Rare Infections Are Just an Airplane Trip Away: Salmonella Typhi Meningitis in a Recent Immigrant to the United States. Am J Med Sci 2005; 330:198-200. [PMID: 16234614 DOI: 10.1097/00000441-200510000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of a 24-year-old immigrant from Bangladesh with Salmonella typhi meningitis, a rare disease in the United States, especially among adults. The common manifestations of meningitis such as neck rigidity and changes in mental status did not develop and Kernig sign was absent. The patient was successfully treated with intravenous ceftriaxone. This case demonstrates the importance of considering endemic infections in the country of origin when recent immigrants and returnees to the United States present with febrile illness.
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Affiliation(s)
- Ia Zagvazdina
- Jackson Memorial Hospital, Jackson Health System, Miami, Florida, USA
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20
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Drevets DA, Leenen PJM, Greenfield RA. Invasion of the central nervous system by intracellular bacteria. Clin Microbiol Rev 2004; 17:323-47. [PMID: 15084504 PMCID: PMC387409 DOI: 10.1128/cmr.17.2.323-347.2004] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infection of the central nervous system (CNS) is a severe and frequently fatal event during the course of many diseases caused by microbes with predominantly intracellular life cycles. Examples of these include the facultative intracellular bacteria Listeria monocytogenes, Mycobacterium tuberculosis, and Brucella and Salmonella spp. and obligate intracellular microbes of the Rickettsiaceae family and Tropheryma whipplei. Unfortunately, the mechanisms used by intracellular bacterial pathogens to enter the CNS are less well known than those used by bacterial pathogens with an extracellular life cycle. The goal of this review is to elaborate on the means by which intracellular bacterial pathogens establish infection within the CNS. This review encompasses the clinical and pathological findings that pertain to the CNS infection in humans and includes experimental data from animal models that illuminate how these microbes enter the CNS. Recent experimental data showing that L. monocytogenes can invade the CNS by more than one mechanism make it a useful model for discussing the various routes for neuroinvasion used by intracellular bacterial pathogens.
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Affiliation(s)
- Douglas A Drevets
- Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
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