1495 A Case of Non-Typhoidal Salmonella (Salmonella Saintpaul) Bacteremia

Abstract

INTRODUCTION: The Center for Disease Control and Prevention (CDC) estimates 1.2 million illnesses and 450 deaths occur due to non-typhoidal Salmonella annually in the United States. Among the different kinds of Salmonella, S. typhimurium and S. enteritidis are the most common serotypes. S. Saintpaul infection is rare and the last outbreak was reported in 2008. We are presenting the case of a 52-year-old woman with S. Saintpaul bacteremia. CASE DESCRIPTION/METHODS: 53-year-old woman with history of bipolar disorder and gastroesophageal reflux disease (GERD) was admitted to the hospital with diarrhea for 2 days. She was noted to be in septic shock and was treated with fluid resuscitation and vasopressors. Examination: temperature 37 °C, blood pressure 66/36 mmHg, pulse 111/minute and saturating 97% on room air. Cardiovascular and respiratory examinations were normal. Abdomen - no tenderness, no peritoneal signs and hyperactive bowel sounds. Laboratory data: white cell count 2.82 × 103/μL, hemoglobin 8.2 g/dL, platelets 152 × 103/μL, sodium 129 mEq/L, potassium 2.6 mEq/L, chloride 93 mEq/L, bicarbonate 15.2 mEq/L, creatinine 5.0 mg/dL, AST 93 IU/L, ALT 35 IU/L, alkaline phosphatase 145 IU/L, total bilirubin 0.5 mg/dL. Blood culture -positive for group B Salmonella. Clostridium difficile PCR - negative. Stool culture - positive for group B Salmonella and was later identified as Salmonella Saintpaul serotype. CT abdomen and pelvis without contrast - wall thickening and inflammatory stranding involving the right hemicolon and the hepatic flexure. Patient was given intravenous antibiotic therapy and follow up blood cultures did not demonstrate growth of Salmonella. Patient's condition steadily improved and she was eventually discharged home. DISCUSSION: Salmonellae are Gram-negative, rod-shaped bacilli and are classified into typhoidal and nontyphoidal groups based on their serotype. Common sources of non-typhoidal Salmonella infection are contaminated food or water and contact with infected animals. In our patient's case, her family raised chicken for eggs and we suspect that to be the source of infection.