Septic abortion caused by Salmonella enteritidis

Intrauterine infection caused by nontyphoidal Salmonella: a literature review

Objectives: Although nontyphoidal Salmonella infections have a prevalence of 0.2-1.8%. It is mostly described in veterinary medicine; it could be responsible for severe intra-amniotic infections in humans. The objective of this review is to describe the clinical and microbiological aspects of intrauterine infection (IUI) caused by nontyphoidal Salmonella.Methods: We reported a case analysis and subsequently conducted a systematic literature review of IUI caused by nontyphoidal Salmonella between 1966 and 2018.Results: In literature nine cases have been reported, and were confirmed by the identification of a nontyphoidal Salmonella in the biological samples. Our review reveals severe clinical presentations in pregnant women. Indeed, sepsis, spontaneous abortions, and fatal outcomes for fetuses were described in 90, 60, and 80% of the cases, respectively. The major clinical symptoms were in majority acute, with high fever, abdominal pain, metrorrhagia, and premature membranes ruptures. Nulliparity is a risk factor and the prognosis depends on the pregnancy stage. All mothers received antibiotics and their outcomes were favorable.Conclusions: Nontyphoidal Salmonella infections can be responsible for severe pregnancy complications. Considering the severe neonatal prognosis, in case of a history of diarrhea and/or sepsis, a search for this pathogen should be considered, and a preventive strategy could be discussed during pregnancy.

First trimester typhoid Fever with vertical transmission of salmonella typhi, an intracellular organism

We report a case in which placental abruption occurred at 16 weeks following first trimester diagnosis and treatment for typhoid fever. Unexpectedly Salmonella enterica serovar Typhi (S. Typhi) was found in fetal tissues at autopsy. Using information from the murine model of typhoid fever in pregnancy, we draw parallels between S. Typhi and L. monocytogenes to develop a plausible hypothesis to explain how this organism was able to cross the placenta in the first trimester to cause abruption, inflammation, and expulsion of the fetus and placenta. We hope that this model for understanding placental infections by the hematogenous route helps to raise awareness that organisms not typically associated with TORCH infection can nevertheless cause placental infection and pregnancy loss.

First-trimester septic abortion due to Salmonella enteritidis Oranienburg

Background: Septic abortion caused by transplacental salmonella infection is extremely rare; there are no reported cases of serotype oranienburg as an etiology.

Case: We describe a patient with non-typhoidal Salmonella enteritidis serotype oranienburg as a cause of first-trimester pregnancy loss. The rapid progression of this patient's septicemia and adverse outcome is described. The epidemiology and natural history of salmonella infections are also discussed.

Conclusion: Non-typhoidal salmonella is still a cause of morbidity in Western countries. This infection can result in rapid-onset fetal demise and septic abortion.

Maternal and neonatal infection with Salmonella heidelberg : a case report

Maternal and neonatal infections with Salmonella typhi have been well documented. There are only two previous case reports of intrauterine infection with non-typhoidal species. This paper presents a third case of maternal septicemia followed by neonatal sepsis with Salmonella heidelberg.

A safe vaccine (DV-STM-07) against Salmonella infection prevents abortion and confers protective immunity to the pregnant and new born mice

Pregnancy is a transient immuno-compromised condition which has evolved to avoid the immune rejection of the fetus by the maternal immune system. The altered immune response of the pregnant female leads to increased susceptibility to invading pathogens, resulting in abortion and congenital defects of the fetus and a subnormal response to vaccination. Active vaccination during pregnancy may lead to abortion induced by heightened cell mediated immune response. In this study, we have administered the highly attenuated vaccine strain ΔpmrG-HM-D (DV-STM-07) in female mice before the onset of pregnancy and followed the immune reaction against challenge with virulent S. Typhimurium in pregnant mice. Here we demonstrate that DV-STM-07 vaccine gives protection against Salmonella in pregnant mice and also prevents Salmonella induced abortion. This protection is conferred by directing the immune response towards Th2 activation and Th1 suppression. The low Th1 response prevents abortion. The use of live attenuated vaccine just before pregnancy carries the risk of transmission to the fetus. We have shown that this vaccine is safe as the vaccine strain is quickly eliminated from the mother and is not transmitted to the fetus. This vaccine also confers immunity to the new born mice of vaccinated mothers. Since there is no evidence of the vaccine candidate reaching the new born mice, we hypothesize that it may be due to trans-colostral transfer of protective anti-Salmonella antibodies. These results suggest that our vaccine DV-STM-07 can be very useful in preventing abortion in the pregnant individuals and confer immunity to the new born. Since there are no such vaccine candidates which can be given to the new born and to the pregnant women, this vaccine holds a very bright future to combat Salmonella induced pregnancy loss.

Effect of Eimeria tenella infection on Salmonella enteritidis infection in chickens

The effect of Eimeria tenella infection on the Salmonella enteritidis infection in chickens was investigated in three experiments. Each experiment consisted of an uninfected control, birds infected with E. tenella, birds infected with S. enteritidis, and birds infected with a combination of E. tenella and S. enteritidis. A dose of 2 x 10(4) sporulated oocysts of E. tenella was given to each chicken. In Experiment 1, each chicken was infected with 10(5) cfu/d of S. enteritidis for 3 consecutive d starting 1 d after coccidia exposure and necropsied 4, 7, 10, and 14 d after coccidial infection. In Experiments 2 and 3, each bird was infected with 10(2) cfu/d and 10(1) cfu/d of S. enteritidis respectively, for 2 d beginning 4 d after coccidia exposure, and were killed 7, 10, and 14 d postinfection with E. tenella. Results showed that interaction between S. enteritidis and E. tenella was significant in Experiments 1 and 2, but not in Experiment 3, manifesting that the cecal Salmonella population were significantly increased by coccidial infection in birds killed 4, 10, or 14 d after coccidia exposure in Experiment 1 and in birds killed 14 d after coccidial infection in Experiment 2. The dose size of S. enteritidis was an important factor for the synergistic relationship between S. enteritidis and E. tenella. Frequency of recovery of S. enteritidis in liver and spleen was not increased by E. tenella infection.

Salmonella thomson outbreak in a Canadian newborn nursery

OBJECTIVE

To determine the mode of salmonella transmission during an outbreak in a newborn nursery.

DESIGN

Outbreak investigation with retrospective review of medical, microbiological and work records, active case-finding, and active surveillance. A case was defined as a newborn with salmonella isolated from any site.

SETTING

University affiliated community hospital near Montreal with 125 active care beds and 3000 deliveries annually.

PATIENTS

Cases were identified from the microbiology reports and public health notifications for one month before to six months after detection of the outbreak. All neonates with diarrhea had stool cultures during the period of observation.

RESULTS

Four cases of neonatal salmonella infection were detected. The index infection was acquired at birth from a mother with severe gastroenteritis from contaminated chicken. The first of five secondary cases - three other neonates and two mothers - was only detected 11 days after departure of the index case. Three of the four infants required intensive treatment and one remained a chronic carrier and was rejected for daycare services. No food or health care worker was associated with infection of neonates. The diapering technique had been changed one month earlier because the hospital had stopped purchasing disposable washcloths.

CONCLUSIONS

Three of the four neonatal salmonella infections caused severe morbidity. The organism was easily transmitted when breaks in technique probably allowed contamination of fomites, survival in the inanimate environment, and subsequent cross-infection to other neonates. Simple unexpected changes in the availability of material resources such as washcloths may have adversely influenced clinical practises with a resultant breakdown in infection control procedures.