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Balaji L, Manoharan H, Prabhakaran N. An Atypical Pathogen at an Atypical Location: A Rare Case of Salmonella-Associated Submandibular Abscess. Cureus 2024; 16:e66026. [PMID: 39221369 PMCID: PMC11366305 DOI: 10.7759/cureus.66026] [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] [Received: 06/23/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Salmonella infections commonly cause gastroenteritis and enteric fever but can also result in extraintestinal infections, especially in immunocompromised individuals. Although rare, Salmonella infection in the head and neck region was found to be more common in diabetics and patients with malignancy. We present a unique case of a 52-year-old immunocompromised man with uncontrolled diabetes who developed a submandibular abscess due to Salmonella Paratyphi B. The patient initially presented with pain, swelling, and difficulty swallowing, which worsened over a week. Diagnostic imaging revealed a well-defined abscess with lymphadenopathy. Management included incision and drainage, followed by identification of Salmonella Paratyphi B and targeted antibiotic therapy based on culture and sensitivity analysis. This case highlights the importance of early recognition, appropriate diagnostic imaging, and targeted antimicrobial therapy in managing uncommon manifestations of Salmonella infection in the head and neck. Continued vigilance and multidisciplinary management are essential for favorable patient outcomes in such cases.
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Affiliation(s)
- Lavanya Balaji
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Harish Manoharan
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Neelusree Prabhakaran
- Department of Microbiology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Tsai MS, Chang GH, Chen WM, Liu CY, Lin MH, Chang PJ, Huang TY, Tsai YT, Wu CY, Hsu CM, Yang YH. The Association Between Decompensated Liver Cirrhosis and Deep Neck Infection: Real-World Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203863. [PMID: 31614776 PMCID: PMC6843924 DOI: 10.3390/ijerph16203863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deep neck infection (DNI) can progress to become a life-threatening complication. Liver cirrhosis, which is related to poor immune conditions, is a likely risk factor for DNI. This study investigated the risk and mortality of DNI in patients with decompensated liver cirrhosis (DLC). METHODS We performed a nationwide cohort study using the National Health Insurance Research Database (NHIRD) in Taiwan. We included a total of 33,175 patients with DLC between 2000 and 2013, from the Catastrophic Illness Patient Database, a subsection of the NHIRD, along with 33,175 patients without cirrhosis who were matched in a 1:1 proportion for age, sex, and socioeconomic status. The occurrence of DNI was the primary study outcome. The risk, treatment, and mortalities of DNI were evaluated in the study and comparison cohorts. RESULTS DLC Patients had a significantly higher incidence of DNI than noncirrhotic patients (p < 0.001). The adjusted Cox proportional hazard regression showed that DLC was associated with a significantly higher risk of DNI (adjusted hazard ratio, 4.11; 95% confidence interval, 3.16-5.35, p < 0.001). The mortality rate in cirrhotic patients with DNI was not significantly higher than that in noncirrhotic patients with DNI (11.6% vs. 9.8%; p = 0.651). CONCLUSIONS This study is the first to investigate the correlation between DLC and DNI. The study findings strongly indicate that DLC is an independent risk factor for DNI. Cirrhotic patients with DNI do not have a significantly poorer survival rate than noncirrhotic patients with DNI. Therefore, physicians should be alert to potential DNI occurrence in DLC patients. Besides this, intensive care and appropriate surgical drainage can yield similar survival outcomes in DLC-DNI and noncirrhosis-DNI patients.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Wei-Ming Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Tsung-Yu Huang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Cheng-Ming Hsu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
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Salmonella neck abscess in a diabetic. IDCases 2019; 17:e00541. [PMID: 31384558 PMCID: PMC6667484 DOI: 10.1016/j.idcr.2019.e00541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/21/2022] Open
Abstract
Salmonella is known to cause invasive illness. However, head and neck abscesses are an unusual presentation of extra-intestinal infection with this organism. We describe a case of Salmonella neck abscess in a diabetic patient. An 18 year old diabetic male was admitted with increasing left sided neck pain and swelling approximately four weeks after gastrointestinal illness. Imaging revealed a left sided neck abscess. Surgical drainage was undertaken. Cultures grew non-typhoid Salmonella species. He was treated with intravenous antibiotics and did well clinically. Salmonella infection should be considered in the differential diagnosis of patients with immunocompromising conditions presenting with neck abscess of unclear etiology.
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Sugimoto R, Suzuki H, Nei T, Tashiro A, Washio Y, Sonobe K, Nakamura Y, Wakayama N, Inai S, Izumiya H. Neck abscess due to Salmonella Choleraesuis: case study and literature review. JMM Case Rep 2017; 4:e005109. [PMID: 29026636 PMCID: PMC5610711 DOI: 10.1099/jmmcr.0.005109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/06/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. We herein describe a case with a neck abscess due to non-typhoidal Salmonella (NTS). NTS habitually reside in our environment and colonize all animals including mammals. Colonizations of pigs, chickens, cows and sheep are important because food poisoning episodes in human are often associated with meat. Extra-intestinal infection due to NTS has numerous presentations and complications, with aortic aneurysms being common. Case presentation. A 26-year-old Japanese male complaining of left-sided neck swelling was referred to our hospital for a suspected deep neck abscess. An enhanced computed tomography scan of the neck revealed a low density lesion in the left-sided deep neck area, and consequently the patient underwent urgent incision and drainage. After this urgent operation, Salmonella Choleraesuis was isolated from a greyish-white abscess. The patient ultimately recovered with antimicrobial administration, though re-incision for lymphadenectomy was necessary. The neck abscess may have developed because he had eaten raw meat. Furthermore, untreated diabetes mellitus was diagnosed at presentation. Conclusion.Salmonella enterica serovar Choleraesuis infections are rare in Japan. NTS are generally recognized as important pathogens in food poisoning globally, and attention is required to avoid the development of extra-intestinal infections. In Japan, the increasing lifestyle diversity in recent years highlights the importance of recognizing rare infections.
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Affiliation(s)
- Ryoji Sugimoto
- Department of Clinical Laboratory, Nippon Medical School Hospital, Japan.,Department of Infection Control and Prevention, Nippon Medical School Hospital, Japan
| | - Hirotaka Suzuki
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Nippon Medical School Hospital, Japan
| | - Takahito Nei
- Department of Infection Control and Prevention, Nippon Medical School Hospital, Japan
| | - Ayaka Tashiro
- Department of Clinical Laboratory, Nippon Medical School Hospital, Japan.,Department of Infection Control and Prevention, Nippon Medical School Hospital, Japan
| | - Yohei Washio
- Department of Clinical Laboratory, Nippon Medical School Hospital, Japan
| | - Kazunari Sonobe
- Department of Clinical Laboratory, Nippon Medical School Hospital, Japan
| | - Yuzo Nakamura
- Department of Clinical Laboratory, Nippon Medical School Hospital, Japan
| | - Nozomu Wakayama
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Nippon Medical School Hospital, Japan
| | - Shunta Inai
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Nippon Medical School Hospital, Japan
| | - Hidemasa Izumiya
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
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Lee YC, Hung MC, Hung SC, Wang HP, Cho HL, Lai MC, Wang JT. Salmonella enterica subspecies arizonae infection of adult patients in Southern Taiwan: a case series in a non-endemic area and literature review. BMC Infect Dis 2016; 16:746. [PMID: 27938338 PMCID: PMC5148916 DOI: 10.1186/s12879-016-2083-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022] Open
Abstract
Background The majority of Salmonella arizonae human infections have been reported in southwestern United States, where rattlesnake-based products are commonly used to treat illness; however, little is known in non-endemic areas. We reviewed and analyzed the clinical manifestations and treatment outcomes in adult patients with S. arizonae infection at our institution. Method A retrospective study was conducted at a regional teaching hospital in southern Taiwan from July 2007 to June 2014. All adult patients diagnosed with S. arizonae infections and treated for at least three days at Chia-Yi Christian Hospital were included. Patients were followed till discharge. Results A total of 18 patients with S. arizonae infections (median age: 63.5 years) were enrolled for analysis, of whom two thirds were male. The three leading underlying diseases were diabetes mellitus, peptic ulcer disease and malignancy. Ten patients had bacteraemia and the most common infection focus was the lower respiratory tract. Most of the patients (72.2%) received third-generation cephalosporins as definitive therapy. In contrast, ampicillin-based regimens (accounting for 45.2%) were the major treatment modalities in previous reports. The crude in-hospital mortality was 5.6%, which was much lower than what was previously reported (22.7%). Conclusions Though uncommon, there were cases of S. arizonae infections in Taiwan. Patients receiving third-generation cephalosporins treatment had better prognosis compared with those treated with ampicillin-based regimen.
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Affiliation(s)
- Yi-Chien Lee
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Miao-Chiu Hung
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Che Hung
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Ping Wang
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Hui-Ling Cho
- Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Mei-Chu Lai
- Department of Laboratory Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan.
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Jha B, Kim CM, Kim DM, Chung JH, Yoon NR, Jha P, Kim SW, Jang SJ, Kim SG, Chung JK. First report of iliacus abscess caused by Salmonella enterica serovar Othmarschen. J Infect Chemother 2015; 22:117-9. [PMID: 26482919 DOI: 10.1016/j.jiac.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Abstract
The non-typhoidal bacterium Salmonella enterica subspecies enterica serovar Othmarschen (Salmonella Othmarschen) is a rare human pathogen. Abscess formation due to non-typhoidal Salmonella infections is a very rare complication in this antibiotic era. We report the first case of iliacus abscess after a short period of gastroenteritis which was caused by non-typhoidal Salmonella enterica belonging to group C1, serovar Othmarschen in a patient without any underlying conditions. A young female presented in our hospital complaining of pain in right hip joint area. She gave a history of watery diarrhea 3 days before the onset of pain. On examination the patient was ill-looking and there was tenderness in the right hip joint area. S. enterica was identified using 16S rRNA gene amplification by PCR and serotyped to be serovar Othmarschen from the pus sample of iliacus abscess. This is the first reported case of iliacus abscess due to Salmonella serover Othmarschen infection. Our case suggests that S. enterica serovar Othmarschen can cause severe focal infections associated with gastroenteritis. The literature on the rare association of Salmonella enterica and abscess formation is reviewed.
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Affiliation(s)
- Babita Jha
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Choon-Mee Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Dong-Min Kim
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Jong-Hoon Chung
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Na-Ra Yoon
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Piyush Jha
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Seok Won Kim
- Department of Neurosurgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Sook Jin Jang
- Department of Laboratory Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| | - Seon Gyeong Kim
- Health and Environment Research Institute of Gwangju Metropolitan City, Gwangju, Republic of Korea.
| | - Jae Keun Chung
- Health and Environment Research Institute of Gwangju Metropolitan City, Gwangju, Republic of Korea.
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Salmonella neck abscess as an opportunistic infection in diabetes mellitus. Case Rep Infect Dis 2013; 2013:708419. [PMID: 24307959 PMCID: PMC3835521 DOI: 10.1155/2013/708419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/03/2013] [Indexed: 11/26/2022] Open
Abstract
Salmonella neck infections represent an uncommon cause of focal salmonellosis. While the incidence of nontyphoid salmonellosis is estimated at over 2 million cases annually, extraintestinal manifestations account for less than 1% of cases. This paper describes two patients with Salmonella neck abscesses as the initial presentation of diabetes mellitus. The first patient was diagnosed as having Salmonella enterica serotype Enteritidis sternocleidomastoid pyomyositis and the second patient Salmonella enterica serotype Typhimurium parapharyngeal abscess. Both patients had elevated hemoglobin A1c levels and had not been previously diagnosed with diabetes mellitus. Salmonella spp. should be on the differential as a causative pathogen in patients presenting with neck abscesses and poorly controlled glucose levels. Diabetes may be a risk factor for salmonellosis due to decreased gastric acidity and prolonged gastric transit time. Prompt incision and drainage accompanied by antibiotics remains the treatment of choice for infected neck abscesses.
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