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CASE REPORT
Year : 2001  |  Volume : 19  |  Issue : 3  |  Page : 151-152
 

Salmonella enteritidis meningitis - A case report


Department of Microbiology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai - 400 022, India

Correspondence Address:
Department of Microbiology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai - 400 022, India

 ~ Abstract 

A male infant admitted with pyogenic meningitis with protein energy malnutrition developed fatal infection due to Salmonella enteritidis. The same organism was isolated from CSF and blood cultures.

How to cite this article:
Varaiya A, Saraswathi K, Tendolkar U, De A, Shah S, Mathur M. Salmonella enteritidis meningitis - A case report. Indian J Med Microbiol 2001;19:151-2


How to cite this URL:
Varaiya A, Saraswathi K, Tendolkar U, De A, Shah S, Mathur M. Salmonella enteritidis meningitis - A case report. Indian J Med Microbiol [serial online] 2001 [cited 2019 Nov 14];19:151-2. Available from: http://www.ijmm.org/text.asp?2001/19/3/151/8151


 Salmonella More Details infections in the newborn, infants and pediatric age group carry special significance as they are associated with high morbidity and mortality. Impaired cell mediated immunity probably explains the high frequency of bacteraemia with non typhoidal  Salmonella More Details in children with HIV infection, malnutrition, leukemia, malaria, schistosomiasis, etc.[1] We present a case report of  Salmonella More Details enteritidis causing meningitis in an infant with protein energy malnutrition.

 ~ Case report Top
A two and half month old male child weighing 3kg admitted at L.T.M.General Hospital, Mumbai, presented with moderate to high grade intermittent fever, bulging anterior fontanelle, refusal of feeds with lethargy and weak cry since one day. There was no history of vomiting, altered sensorium, unconciousness or convulsion. Past history revealed that the patient was admitted in a private nursing home 18 days back for acute gastroenteritis. The child was born near term, by normal delivery, cried immediately after birth with no antenatal, intranatal and postnatal complications. He was already immunized with BCG, OPV1 and DPT1.
On examination, child was lethargic, hypothermic with regular heart rate of 160/min. Respiratory rate was 30/min with shallow respiration. The child had generalized loss of subcutaneous fat with protein energy malnutrition (PEM) grade 4. No pallor, cynosis, clubbing, icterus or lymphadenopathy was present. Scorbutic rosary was noted. Examination of skull showed anterior fontanelle 3x3 cm, bulging and pulsatile. No evidence of cranial nerve deficit was seen. Examination of motor system showed increased tone in all the four limbs, hyperreflexia with clonus, power more than grade 3. The patient had no meningeal signs at the time of admission. Skin turgor was markedly reduced.
Investigations done on the day of admission revealed that he was HIV antibody negative, HBsAg was negative, VDRL was non reactive. The complete hemogram showed that total erythrocyte count was 3.4 million/c.mm., haemoglobin was 9.1 gm%, total leucocytes being 18,000/c.mm - the differential count showed 83% neutrophils, 15% lymphocytes and 2% eosinophils. Platelet count was adequate. Erythrocyte sedimentation rate (ESR) was 90 mm at the end of one hour by Westergreen's method.
Lumbar puncture revealed turbid cerebrospinal fluid (CSF). CSF cell count showed 80% neutrophils and 20% lymphocytes. CSF protein was 85 mg/dL and glucose was 32 mg/dL. Both CSF and blood were sent for culture. Gram staining of CSF showed pus cells with gram negative bacilli. CSF and blood were processed as per standard laboratory techniques.[2] The patient was treated with intravenous (IV) ampicillin, IV amikacin, IV mannitol along with IV fluids. The patient developed altered sensorium while in the hospital within 24 hours of admission and died within 48 hours of admission. No autopsy was performed. The CSF and blood culture grew  Salmonella More Details enteritidis sensitive to gentamicin, amikacin, chloramphenicol, cefuroxime, ceftriaxone and cefotaxime, ciprofloxacin and a combination of amoxicillin and clavulinic acid. The isolate was resistant to ampicillin. The two isolates (from blood and CSF) sent for identification to National  Salmonella More Details Reference Centre, Lady Hardinge Medical College, New Delhi, were confirmed as  Salmonella More Details enteritidis.

 ~ Discussion Top

Approximately 50 to 75% of non typhoidal  Salmonella More Details meningitis occur in the first four months of life.  Salmonella More Details along with other serotypes is commonly associated with bacteraemia and has a propensity to invade the blood stream.[1] Jayashela et al from Central Research Institute, Kasauli documented 20 isolates of S.enteritidis causing meningitis showing that 8% of  Salmonella More Details meningitis was due to S.enteritidis which was the commonest serotype isolated from infants aged 3 days to 9 months with  Salmonella More Details meningitis.[3] In a study conducted by Lee et al,  Salmonella More Details enteritidis was the commonest serotype isolated from infants aged 3 days to 9 months.[4]
There are many reports that highlight malnutrition as a predisposing factor. Hadfield et al have reported multiple drug resistant  Salmonella More Details enteritidis from paediatric patients presenting as meningitis, gastroenteritis among many other conditions, the predisposing factors being young age and debilitation from malnutrition and measles. Our isolate was sensitive to gentamicin, amikacin, chloramphenicol, cefuroxime, ceftriaxone and cefotaxime, ciprofloxacin and a combination of amoxicillin and clavulinic acid. The mortality among the infected patients is reported to be 27.8%.[5] Berkowitz has reported  Salmonella More Details enteritidis among other organisms causing bacteraemia associated with gastroenteritis, pneumonia or meningitis from children with severe PEM.[6]
In our patient, malnutrition was the predisposing factor. Moreover, neonates and young infants less than 3 months of age, themselves are conditions that increase the risk of  Salmonella More Details bacteremia.[7] Impaired immunity in patients with HIV infection and malnutrition amongst many other conditions leads to increased risk of  Salmonella More Details gastroenteritis.[7] S.enteritidis meningitis has been reported by Workman et al from a four week old infant.[8] The overall mortality rate has been reported to be 15% in children with extraintestinal non typhoidal infections.[9] No vaccine against non typhoidal  Salmonella More Details infections is available as yet.[7] 

 ~ References Top

1.Gomez HF, Cleary TG. In : Text book of Pediatric Infectious Diseases, 4th ed. Geigin RD and Cherry JD, Eds (W.B.Saunders Co., Pennsylvania) 1998; Vol I. 1321-1334.  Back to cited text no. 1    
2.Baron EJ, Peterson LR, Finegold SM. Conventional and rapid microbiological methods for identification of bacteria and fungi. In : Bailey and Scott's Diagnostic Microbiology, 10th ed. (The C.V.Mosby Co., St.Louis) 1998:167-187.  Back to cited text no. 2    
3.Jayashela M, Saxena SN. Salmonella isolations from uncommon sites: The Indian situation : A review. Indian J Med Microbiol 1990; 8:116-120.  Back to cited text no. 3    
4.Lee WS, Puthucheary SD, Omar A. Salmonella meningitis and its complications in infants. J Pediatr Child Health 1999; 35:379-382.  Back to cited text no. 4    
5.Hadfield TL, Monson MH, Wachsmuth IK. An outbreak of antibiotic resistant Salmonella enteriditis in Liberia, West Africa. J Infect Dis 1985;151-790-795.  Back to cited text no. 5    
6.Berkowitz FE. Bacteraemia in hospitalized black South African children. A one-year study emphasizing nosocomial bacteraemia and bacteraemia in severely malnourished children. Am J Dis Child 1984;138:551-556.  Back to cited text no. 6    
7.Ashkenazi S, Cleary TG. In : Nelson Textbook of Pediatrics, 15th ed. Bebram RE, Kliegman RM, Arvin AM, Eds (W.B.Saunders Co., Pennsylvania) 1996, book 1. 784-790.  Back to cited text no. 7    
8.Workman MR, Price EH, Bullock P. Salmonella meningitis and multiple cerebral abscesses in an infant. Int J Antimicrob Agents 1999;13:131-132.  Back to cited text no. 8    
9.Lee WS, Puthucheary SD, Parasakthi N.Extra-intestinal non-typhoidal Salmonella infections in children. Ann Trop Pediatr 2000; 20:125-129.  Back to cited text no. 9    
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