Case ReportsPneumonia Due to Salmonella Typhimurium Mohammed Azher, MRCP Faisal El-Kassimi, and Abdul Hamid ChaglaPhD Mohammed Azher Address reprint requests and correspondence to Dr. Azher: Department of Medicine (38), College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia. From the Department of Medicine, College of Medicine, King Saud University, Riyadh Search for more papers by this author , Faisal El-Kassimi From the Department of Medicine, College of Medicine, King Saud University, Riyadh Search for more papers by this author , and Abdul Hamid Chagla From the Department of Microbiology, College of Medicine, King Saud University, Riyadh Search for more papers by this author Published Online:1 May 1991https://doi.org/10.5144/0256-4947.1991.341SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionSalmonellosis is primarily an intestinal infection. Extraintestinal invasion by the organism is rare and mainly occurs in immunocompromised hosts. Endocarditis, epidural abscess, brain abscess, and splenic abscess have been reported in this context[1–5]. Salmonellae are a very rare cause of pneumonia, even in immunosuppressed patients[4]. We report a case of bronchopneumonia caused by Salmonella typhimurium in a patient with systemic lupus erythematosus (SLE) and pulmonary fibrosis.CASE REPORTA 25-year-old woman was admitted with diarrhea and fever of one week's duration. She had no abdominal pain or blood in her stools. Three days after admission, cough and expectoration of mucopurulent sputum developed. She was known to have SLE accompanied by fibrosing alveolitis and chronic respiratory failure, for which she had been taking oral prednisolone for the previous 2 years. The dose of steroids had been gradually tapered, but she had been taking 20 mg of prednisolone for one month before admission.Examination revealed a febrile woman (39.5°C) with a pulse rate of 120/min, cyanosis, and tachypnea (respiratory rate, 40/min). Chest examination showed bilateral basal inspiratory and expiratory crackles. Abdominal and rectal examination findings were normal. Her biochemistry and blood pictures were normal (white cell count, 8.8 × 10). Arterial blood gas values while breathing room air were: PaO2, 40 mm Hg (PaO2 before this illness was approximately 60 mm Hg); PaCO2, 34 mm Hg; pH, 7.35; and HbO2 saturation, 76%, Chest x-ray study showed bronchopneumonic shadows in both lung bases superimposed on an old micronodular infiltrate of pulmonary fibrosis. Salmonella typhimurium was grown from both sputum and blood on several occasions and organisms from both sites had identical biochemical and serological profiles. Her stool cultures on three separate occasions were negative for Salmonella.The patient was successfully treated with intravenously administered ampicillin, oxygen inhalation, and chest physiotherapy. Her blood gas values and chest x-ray appearance returned to baseline after three weeks of treatment. Her stools were repeatedly negative for salmonellae and there was no evidence of gallbladder disease before or after the illness.The isolates from sputum as well as blood culture were identified as S. typhimurium based on their growth characteristics (i.e., non-lactose–fermenting colonies on MacConkey's agar), biochemical profile using the Analytical Profile Index (API-system), and slide serological tests. The anti-biogram showed that the organism was sensitive to ampicillin, cotrimoxazole, gentamicin, chloramphenicol, and erythromycin.DISCUSSIONSalmonellosis is primarily an intestinal infection but there have been rare reports of extraintestinal spread[1–5]. Salmonella pneumonia is very rare even in immunosuppressed individuals[6,7]. Canney et al[8] reported on one patient with this condition who was receiving chemotherapy for non-Hodgkin's lymphoma. Gratten et al[9] from Papua-New Guinea described four pre-school children with Salmonella pneumonia due to S. choleraesuis and attributed these cases to contact with pigs.In the patient reported here, the underlying predisposing factors were corticosteroid therapy and the SLE. Salmonella bacteria are facultative intracellular organisms, the main host defense mechanism for such infections being mediated by cellular immunity and macrophage activity. It is possible that our patient may have possessed a defect in cellular immunity due to SLE and that combined with the corticosteroid treatment may account for the association with this type of infection.The influence of pulmonary fibrosis in the development of bronchopneumonia is not entirely clear. It has been postulated that patients with pulmonary fibrosis are more prone to pulmonary infections as a result of defective mucociliary clearance and disturbed tissue macrophage function[10].Although our patient gave a history of mild diarrhea, some patients may not have any gastrointestinal symptoms[11]. This may reduce the index of suspicion of salmonellosis, especially in areas of low endemicity. In immunosuppressed patients, the mortality from Salmonella infections is approximately 10%; therefore, the early use of appropriate antibiotics is mandatory.We recommend that patients with pneumonia who live in tropical areas where there is a high incidence of Salmonella infection should be carefully evaluated for this organism, especially if they are immunocompromised or have underlying pulmonary fibrosis.ARTICLE REFERENCES:1. Mokhobo KP. "Typhoid cardiac involvement" . S Afr Med J. 1975; 49: 55–6. Google Scholar2. Herbert DA, Ruskin J. 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Clin Radiol. 1985; 36 (5): 459–60. Google Scholar9. Gratten M, Barker J, Rongap A. "Pneumonia due to Salmonella choleraesius in infants in Papua New Guinea (letter)" . Lancet. 1983; 2: 580–1. Google Scholar10. Fishman AP. Pulmonary diseases and disorders, ed 2. New York: McGraw Hill, 1988;720. Google Scholar11. Olutola PS, Familusi JB. "Salmonella typhi pneumonia without gastrointestinal manifestations" . Diagn Imag Clin Med. 1985; 54 (5): 263–7. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 11, Issue 3May 1991 Metrics History Accepted29 July 1990Published online1 May 1991 ACKNOWLEDGMENTWe are grateful to Ms. Bennie Campos and Ms. Mimi S. Gurrea for their secretarial assistance in typing the manuscript.InformationCopyright © 1991, Annals of Saudi MedicinePDF download