Salmonella Meningitis Research Articles

Salmonella meningitis with hydrocephalus as complication in children: A case series

Background: Bacterial meningitis by salmonella serotype is a rare infection among neonates and young children. The treatment of salmonella meningitis requires bactericidal agents that are capable of penetrating into cerebrospinal fluid (CSF). Acute complications of bacterial meningitis mainly include hydrocephalus, subdural collection, cerebral infarction, ventriculitis, empyema, intracranial abscess and cranial nerve palsy. Two Cases Presentation: First case, 1 months-old boy brought to the general hospital with chief complaint of fever. Patient had decreased of consciousness and bulging of anterior fontanella. Analysis of cerebrospinal fluid (CSF) showed Pandy test (+4) and None test (+4), high protein 369 mg/dl (mononuclear 44%, polymorphonuclear 56%), liquor glucose 2 mg/dl, CSF culture and blood culture resulted salmonella. Electrolyte and blood sugar was normal, complete blood count showed leukocytes 13.96x 103/µL and mild normochromic normocytic anemia. Head CT scan revealed communicating hydrocephalus. Second case, 6 months-old boy brought to general hospital with seizure as chief complaint. Cerebrospinal fluid (CSF) analysis showed Pandy test (+4) and None test (+4), high protein 569 mg/dL, liquor glucose 26 mg/dL, CSF culture and blood culture results found salmonella sp. Head CT scan revealed subdural hygroma at frontoparietal. Patient was treated by 3rd generation of cephalosporins (ceftriaxone) for 4 weeks. Patient discharge from hospital. Summary: Management of salmonella meningitis include administration of empiric antibiotic, supportive treatment and management of complication. High dose of antibiotic is given empirically without waiting for the results of culture. Learning Points: Clinical manifestations and outcome of meningitis salmonella

Neonatal Salmonella Meningitis With Subdural Empyema: A Case Report.

To the Editors: Salmonella species can cause a variety of neonatal infections which are most prevalent in sub-Saharan Africa. Salmonella meningitis is associated with long-term neurologic sequelae1 including seizures, hydrocephalus, subdural effusions, empyema, ventriculitis, hemorrhage and abscess.2 The present case describes a neonate with Salmonella meningitis with subdural empyema. A 12-day-old full-term female presented to the emergency department for a 1-day history of fever, decreased feeding, and a shorter, gasp-like breathing pattern. The baby was tachycardic and febrile. Per patient’s mother, both she and the infant’s brother were suffering from diarrhea 3 days before onset of the infant’s symptoms. A full sepsis workup was initiated, including blood, urine and cerebrospinal fluid cultures. The patient was empirically started on intravenous ampicillin and gentamicin pending culture results. Additionally, a respiratory pathogen panel via polymerase chain reaction performed on the same day indicated positive results for coronavirus disease 2019 (COVID-19). The patient was admitted for further management of presumed neonatal sepsis and respiratory monitoring of COVID-19 infection. The patient was subsequently found to have positive blood culture and cerebrospinal fluid gram stain for Gram-negative rods. Speciation and sensitivities later grew Salmonella species with sensitivity to ampicillin and ceftriaxone. Magnetic resonance imaging of the brain was significant for diffuse right leptomeningeal enhancement consistent with meningitis and subdural empyema. No neurosurgical intervention was recommended. Ampicillin and gentamicin were discontinued after 3 days of treatment, and ceftazidime was started for treatment of salmonella meningitis. Ceftriaxone was considered as the standard treatment for invasive Salmonella infection, but was inappropriate due to mildly elevated bilirubin on admission (Table 1) and patient’s age. TABLE 1. - Admission Labs Complete blood count With Differential Day 1 of Admission White blood cell count 6.4 × 103/µL Hemoglobin/hematocrit 12.6/37.3 g/dL Platelets 564 × 103/µL Segmented neutrophils 40% Bands 24% Lymphocytes 26% Monocytes 7% Urinalysis Color Dark yellow Specific gravity 1.021 pH 7.0 Protein 2+ Glucose Trace Ketones Negative Bilirubin Negative Blood Negative Nitrites Negative Urobilinogen 0.2 Leukocyte esterase 2+ Urine microscopy White blood cells >50 Red blood cells 11.1 Squamous epithelial 5.3 Bacteria 40 Casts 3.9 Chemistry Sodium 138 mmol/L Potassium 4.1 mmol/L Chloride 107 mmol/L Bicarbonate 22 mmol/L Blood urea nitrogen/creatinine 8/0.37 mg/dL Glucose 108 mg/dL Total bilirubin 9.6 mg/dL Total protein 6.2 g/dL Albumin 3.1 g/dL Alanine transaminase/aspartate transaminase 18/23 Units/L Alkaline phosphatase 143 Units/L Cerebrospinal fluid Color Cloudy White blood cells 667 cu/mm Red blood cells 42,500 cu/mm Segmented neutrophils 90% Lymphocytes 8% Monocytes 1% Eosinophils 1% Basophils 0% Inflammatory markers C-reactive protein (admission) 3.06 mg/dL C reactive protein (hospital day #2) 25 mg/dL On the third day of admission, a repeat respiratory pathogen panel showed the patient to be COVID-19 negative, and it was concluded that the initial positive test was likely a false positive. Repeat blood cultures drawn on day 4 of admission were negative. On day 8 of admission, a peripherally inserted central catheter line was placed for long-term parenteral antibiotics. On day 10 of admission, ceftazidime was discontinued and switched to ceftriaxone after a repeat complete metabolic panel showed normalized bilirubin levels. Ceftriaxone was selected (in lieu of ampicillin) to minimize peripherally inserted central catheter line access thereby reducing probability of central line–associated bacterial infection. Inflammatory markers and bilirubin were trended closely due to use of ceftriaxone. A 6-week course of treatment was completed with no further complications and improvement of radiologic findings. The patient was discharged with no apparent neurological deficits. Her development was ascertained by phone call and the child continues to develop typically. Previous case reports indicate that third generation cephalosporins are ideal for management of salmonella meningitis due to their bactericidal properties.3,4 This case offers a suggested treatment course of neonates with transition from ceftazidime to ceftriaxone showing satisfactory results in the treatment of neonatal Salmonella sepsis and meningitis complicated by empyema. ACKNOWLEDGMENTS The authors thank the patient and family for their participation in this report.

Successfully Treated Case of Non-Typhoidal Salmonella Meningitis in an Otherwise Healthy 5 Months Old Infant: A Case Report

Acute bacterial meningitis in infants is a medical emergency requiring prompt diagnosis and early institution of empirical antibiotic therapy. Non-typhoidal salmonella (NTS) is a major cause of uncomplicated infectious diarrhoea worldwide; however NTS meningitis is extremely uncommon beyond the neonatal period with very few cases being reported in the literature and has been associated with increased mortality and morbidity with mortality rates of up to 40-70% reported in recent studies. NTS being a facultative intracellular organism does not respond to conventional antibiotic therapy and therefore failure and relapse rates are higher particularly with meningitis. We report a rare case of a five month old infant with non-typhoidal salmonella meningitis who was successfully treated with prolonged duration of antibiotic therapy.

Salmonella meningitis with thrombotic microangiopathy in an exclusively breast-fed infant: Case report

Salmonella species is now a leading cause of meningitis in the developing world. We report a 6-month-old fully vaccinated baby girl who presented with high-grade fever and seizures. Her CSF and blood cultures grew non-typable Salmonella strains. The child was treated with antibiotics and anti-epileptics and discharged home after 2 weeks of hospital stay.Children with salmonella meningitis may present with life-threatening manifestations in the absence of gastrointestinal symptoms.

PROGRESSIVE DECREASE IN T CELL QUANTITY AND FUNCTION IN A PATIENT WITH IL-12 PATHWAY DEFECT

Introduction T helper 1 (TH1) and IFN-g are key players in the cell-mediated immune response. Furthermore, IL-12 is an important cytokine that promotes TH1 cell differentiation and mediates its affects through signal transducer and activator of transcription 4 (STAT4). Mutations in the gene encoding the IL-12 receptor beta1 subunit have been identified in patients with disseminated Salmonella and nontuberculous mycobacterial (NTM) infections or disseminated Bacillus Calmette-Guerin (BCG) infection following vaccine administration. Case Description 5-month old female with history of recurrent salmonella enteritis and meningitis at 3 weeks and 3 months of age who presented to our Immunology clinic for an immune evaluation. Initial T cell lymphocyte subsets showed elevated CD3, CD4, CD8 and CD16/CD56 absolute values. Her mitogen culture proliferation assay was reported as low lymphocyte proliferation to ConA and PHA, however based on our assessment she had greater than tenfold response to stimulus and therefore normal function. The patient's lymphocyte subsets have been reassessed on a yearly basis and have showed progressive decline. This year, her CD4 and CD8 were 754 and 338 respectively. Mitogen proliferation culture re-assessment this year also showed significant decline in her T cell function and she was therefore started on Bactrim prophylaxis. Discussion Our patient showed progressive decline in her T cell subset values and decrease in overall function. Although classically MSMD (mendelian susceptibility to mycobacterial disease) patients showed increase susceptibility to disseminated BCG and Salmonella disease and is managed with interferon gamma and azithromycin prophylaxis, our patient now requires additional Bactrim prophylaxis. IL-12 Signaling Pathway

Five-year review of non-typhoidal salmonella meningitis in Cape Town, 2010 - 2015

Five-year review of non-typhoidal salmonella meningitis in Cape Town, 2010 - 2015

Salmonella Meningitis Presenting With Multiple Microabscesses in the Brain in a Young Infant: A Case Report

We report the case of a 4-month-old girl who presented with salmonella meningitis with multiple microabscesses in the brain, and was managed with appropriate intravenous antibiotics for 4 weeks with clearance of microabscesses on repeated imaging. Int J Clin Pediatr. 2016;5(1):13-14 doi: http://dx.doi.org/10.14740/ijcp236w

856 Salmonella Enteritidis Meningitis in a Case Report

IntroductionSalmonella are the usual agents of gastrointestinal infections caused by ingesting food or water contaminated responsible for gastroenteritis, infectious forms with predominant symptoms represent 5–10% of all salmonellosis They occur...

The outcome of non-typhoidal salmonella meningitis in Malawian children, 1997–2006

The clinical course and outcome of non-typhoidal salmonella (NTS) meningitis in Malawian children over a 10-year period (1997-2006) is described. Demographic, clinical and laboratory data were collected for all children over 2 months of age admitted with salmonella meningitis to Queen Elizabeth Central Hospital from 1997 to 2006. In the 1st year, salmonellae were susceptible to chloramphenicol, and children received 2 weeks of chloramphenicol treatment. When NTS resistance to chloramphenicol started to appear in 1998, treatment was changed to ceftriaxone. From 2002, the duration of antibiotic therapy was extended to 4-weeks which included 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral ciprofloxacin. The in-hospital case fatality rate (CFR) was 52.3% (48.2% until 2002 and 53.9% after prolonged antibiotic therapy was introduced). Of the survivors, one in 12 (8.3%) became completely well (sequelae-free) in the period 1997-2001 while 18 of 31 survivors (58.1%) made a complete recovery during 2002-2006 (p<0.01). After the 4-week course of antimicrobial therapy was introduced, the number of relapses or recurrences fell from nine in 15 (60%) survivors treated with chloramphenicol or ceftriaxone to three in 35 (8.7%) survivors who received 4 weeks of antibiotics (p<0.0001). In Malawi, salmonella meningitis has a CFR of approximately 50%, which has remained constant over many years. Residual morbidity, however, has decreased over 10 years, despite rising numbers of multi-drug-resistant cases of NTS. This improvement might be owing to better treatment and management and/or reduced pathogenicity of the multi-drug-resistant bacteria.

Méningites à salmonelles du nouveau-né et du nourrisson. Intérêt des fluoroquinolones

To analyze the characteristics of the salmonella meningitis in new-borns and infants in France and sum up the complications and treatments. The observations were taken from the national observatory of bacterial meningitis in children. The medical reports from paediatric and neo-natal departments have been analysed for each patient. The case reports concern 9 newborn babies and infants aged from twelve days to fifteen months (median 4 months). The initial clinical and biologic signs were not specific. Three children had had a digestive infection in the previous weeks, with a positive coproculture for salmonella in two of them. Two infants developed convulsions : 1 of them was hospitalized in intensive care unit ; he also had osteo-articular localisation. All nine children have been treated with third-generation cephalosporins (C3G) and seven of them with quinolones. A newborn who only had cefotaxime and amoxicilline relapsed when the treatment stopped. He showed serious neurological complications and died at the age of eight months. Salmonella meningitis are rare in France (our estimation is 0.2 % of all bacterial meningitis). They are more frequent in "emergent countries" (between 1 to 10 %). In such countries, there are important neurological complications and high relapse rates, often followed by death. Literature study and our observations show that the use of ciprofloxacine reduce the frequency of complications and risk of relapse. The treatment currently advised for salmonella meningitis is to combine in first C3G with quinolone for at least three weeks. Risks of meningitis in case of digestive salmonellosis in infants urge discussion for preventive use of quinolones, particularly before the age of 6 months.

Salmonella Meningitis in an Immunocompetent Adult

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.

Relapsed Nosocomial Neonatal Salmonella enterica sv. Typhi Meningitis: A Case Report

Salmonella enterica sv. Typhi (S typhi), the causative organism of enteric fever which is found mainly in the developing countries, is a severe systemic disease with a worldwide frequency estimated as 12-33 million cases per year. It is transmitted not only through contaminated food and beverages, but also via a vertical mechanism during the last trimester of pregnancy. Salmonella enterica sv. Typhi meningitis of the newborn is rare, but is important as its mortality, morbidity and relapse rates are high. The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Third generation cephalosporines should be the first line drug of choice. However, cefotaxime used for 4 weeks could not prevent relapses. Meropeneme and ciprofloxacine could be used alternatively. We report a neonatal nosocomial S typhi meningitis case relapsing in spite of cefotaxime usage for 4 weeks, which was then treated with ciprofloxacine.

Nosocomial outbreak of neonatal Salmonella enterica serotype Enteritidis meningitis in a rural hospital in northern Tanzania.

BackgroundClinicians at Haydom Lutheran Hospital, a rural hospital in northern Tanzania noted an unusually high case-fatality rate of pediatric meningitis and suspected an outbreak of an unknown agent or an organism resistant to the empirical therapy.MethodsWe established a provisional microbiology laboratory to investigate the suspected outbreak. Blood and spinal fluid specimens were taken from children below the age of seven years with suspected meningitis. The blood and spinal fluid specimens were inoculated in commercial blood culture bottles and locally prepared Thayer-Martin medium in slanted tubes, respectively. The bacterial isolates were sent to Norway for further investigation, including susceptibility testing and pulsed-field gel-electrophoresis (PFGE).ResultsAmong 24 children with suspected meningitis and/or septicemia, five neonates had meningitis caused by Salmonella enterica serotype Enteritidis, all of whom died. Two children had S. Enteritidis septicemia without meningitis and both survived. Genotyping with PFGE suggested a clonal outbreak. The salmonella strain was resistant to ampicillin and sensitive to gentamicin, the two drugs commonly used to treat neonatal meningitis at the hospital.ConclusionThe investigation reminds us that nontyphoidal salmonellae can cause meningitis associated with very high case-fatality rates. Resistance to multiple antimicrobial agents increases the risk of treatment failure and may have contributed to the fatal outcome in all of the five patients with salmonella meningitis. The investigation indicated that the outbreak was nosocomial and the outbreak subsided after hygienic measures were instituted. Establishing a provisional microbiological laboratory is a valuable and affordable tool to investigate and control outbreaks even in remote rural areas.

Results of aortic valve-sparing operations: Experience with remodeling and reimplantation procedures in 65 patients

Background Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes. Methods A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians. Results Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis “Valsalva graft” was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism. Conclusions Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.

Méningites à salmonelles de l'enfant à Libreville. Étude rétrospective de neuf observations

Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid. Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels. The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.

Recurrent Salmonella enteritidis Meningitis in a Patient with AIDS

The profound impairment of cellular immunity associated with HIV infection predisposes to salmonella infections with recurrent bacteremia as a well recognized opportunistic infection in patients with AIDS. However, salmonella meningitis is extremely rare in this group of patients and only 4 cases have been reported so far. We present 1 case of recurrent Salmonella enteritidis meningitis in an AIDS patient. The infection recurred despite prolonged antimicrobial therapy. Treatment of salmonella infections in AIDS patients may be very difficult and, in some cases, lifelong maintenance therapy may be required.

Salmonella meningitis and infection with HIV

Patients infected with HIV demonstrate increased susceptibility to serious infections with non-typhoidal salmonellae. However, no cases of salmonella meningitis have been reported in this population. We now report three cases of salmonella meningitis which occurred in a population of 1800 patients with AIDS or AIDS-related complex at our hospitals. The incidence of meningitis complicating salmonella infection in our HIV-infected population appears to be much higher than that reported in non-AIDS patients (7.5 versus 0.15%). All had cerebrospinal fluid parameters consistent with bacterial meningitis, and two of three revealed organisms on cerebrospinal fluid Gram stain. Two presented with a fulminant illness and died despite therapy; the third developed a brain abscess associated with a relapse of meningitis. Salmonella meningitis should be considered as a cause of acute neurological deterioration in patients at risk for HIV-related disease. Relapses may occur, and mortality is high.

Salmonella meningitis: report of five cases.

Five cases of salmonella meningitis were encountered during a period of 5 years at Medical College Hospital, Rohtak. All were male children and four of them were below 5 years of age. Salmonella etiology had not been though of prior to laboratory confirmation in any of these cases. Early specific diagnosis followed by appropriate therapy produced good response in all except one infant who expired. Of the 5 salmonella isolates three were S. typhimurium and two S. typhi.

Salmonella meningitis in the newborns and young infants in Jakarta, Indonesia.

Experience with salmonella meningitis in the newborn and young infants below the age of 40 days hospitalized during the period 1976- 1979 was described. They constituted 8.6% of the 324 cases of purulent meningitis in children in approximately 20.000 admissions in the 4-year-period. There was a preponderance of males among the patients and the youngest case was 2 days old. The Salmonella serotypes isolated from cerebral spinal fluid were havana ( 17 cases J and oranienburg (11 cases). Of particular interest is the fact that 4 of the infants and their mothers showed the identical offending organisms isolated from the spinal fluid and rectal swab. The most common predisposing maternal obstetric complications were fever and premature rupture of the amniotic membranes, whereas the predisposing factors in the infants were infections, asphyxia arul prematurity. Ventriculitis, subdural effusion/empyema and hydrocephalus were the most common complications. A brief discussion has been made on the appropriate time to perform ventricular tap.

Recovery from salmonella meningitis after treatment with furaltadone (Altafur)

Summary Apparent successful therapy with furaltadone, administered intravenously, of an infant with Sal. schwarzengrund meningitis is described. The patient had failed to recover from the infection after previous treatment with several antibiotics. Furaltadone was tolerated rather well.