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CASE REPORT
Year : 2003  |  Volume : 21  |  Issue : 1  |  Page : 59-60
 

A case of injection abscess due to salmonella typhi


Department of Microbiology, MS Ramaiah Medical College, Bangalore - 560 054, India

Correspondence Address:
Department of Microbiology, MS Ramaiah Medical College, Bangalore - 560 054, India

 ~ Abstract 

To the best of our knowledge, injection abscess due to Salmonella typhi has not been reported earlier. A patient with fever of unknown origin was diagnosed as suffering from typhoid fever, administered a course of ceftrioxone but patient developed an injection abscess due to S.typhi, abscess was drained and patient was started on ciprofloxacin to which he responded favourably.

How to cite this article:
Raghunath R, Ashok A C, Sridaran D, Indumathi V A, Belwadi M R. A case of injection abscess due to salmonella typhi. Indian J Med Microbiol 2003;21:59-60


How to cite this URL:
Raghunath R, Ashok A C, Sridaran D, Indumathi V A, Belwadi M R. A case of injection abscess due to salmonella typhi. Indian J Med Microbiol [serial online] 2003 [cited 2019 Oct 22];21:59-60. Available from: http://www.ijmm.org/text.asp?2003/21/1/59/8314


S.typhi infection (typhoid fever) is common in developing countries. Untreated S.typhi infections lead to persistent high fever, severe anorexia, weight loss and changes in sensorium. The most common complications include intestinal bleeding or perforation, necrotising cholecystitis and rarely hepatitis, meningitis, nephritis, myocarditis, bronchitis, pneumonia, septic arthritis, osteomyelitis, parotitis and orchitis.[1] To the best of our knowledge S.typhi injection abscess has not been reported earlier.

 ~ Case reports Top

A male patient aged 48 years attended our hospital with complaints of high fever (1030F) and anorexia. He was admitted and investigated. The patient was diagnosed as suffering from typhoid fever, as his Widal test showed significant titers of 640 for T 'H' and 320 for T 'O' agglutinins. Blood cultures failed to yield S.typhi. Patient was treated with ceftrioxone to which he had responded favorably and was discharged after four days with an advice to continue the antibiotic for six more days.
Nine days later the patient attended the Surgical out patient department with high fever (103F), pain and swelling at the right gluteal region, of two days duration. He was diagnosed as suffering from gluteal abscess (? injection abscess), which was incised and 300 to 350 mL of non foul smelling, thick, purulent pus was drained and dispatched to the Department of Microbiology, where it was processed according to standard protocols.2 The pus yielded a pure growth of S.typhi.[3] Patient's Widal test showed very high titers of 5120 for T 'H' and 320 for T 'O' agglutinins.
Repeat cultures of pus and tissue from the abscess cavity yielded pure growth of S.typhi. Blood and urine cultures failed to yield S.typhi, but faeces culture yielded S.typhi.
All the S.typhi isolates from the lesion as well as faeces frankly agglutinated when mixed with the patient's serum and had the same antibiotic sensitivity pattern by the standard Kirby- Bauer disc diffusion method4 (sensitive to- ciprofloxacin, cefotaxime, ceftrioxone, cefuroxime, amikacin, netilmicin, and resistant to ampicillin, amoxycillin plus clavulinic acid, chloramphenicol, cotrimoxozole).
The patient was started on intravenous ciprofloxacin and after four days his condition improved. Repeated cultures of discharge from the abscess drainage wound and faeces yielded no growth of S.typhi after the treatment. The abscess cavity showed signs of resolution and thus the patient was discharged with an advice to continue oral ciprofloxacin and regular follow-up visits.

 ~ Discussion Top

Complications in S.typhi infection is not uncommon and some unusual complications like splenic abscess, splenic rupture, hepatic abscess and multiple subcutaneous abscesses due to S.typhi have been reported.[5],[6],[7],[8] But S.typhi injection abscess has not been reported. Prior to the first visit to our hospital, the patient had been investigated extensively for pyrexia of unknown origin, including urine for culture and sensitivity, peripheral blood smear for malarial parasites and Widal test, none of which had showed any abnormality except for a rise in the ESR (56 mm/1st hour) and the patient was started on intramuscular antipyretics and was given a course of chloroquine and had taken anti -tubercular treatment for two weeks. However, there was no response to the treatment and his condition worsened. He came to our hospital for treatment. Newer diseases are emerging and common diseases are presenting in newer ways therefore one should always be on the look out for unusual presentations of common diseases. 

 ~ References Top

1.Harrison's Principles of Internal Medicine. (Ed.), Keusch GT, (McGraw-Hill, New York), 1998, 952.  Back to cited text no. 1    
2.Collee JG, Fraser AG, Marmion BP, Simmons A. In: Mackie and McCartney Practical Medical Microbiology, 14th ed, (Churchill Livingstone, London), 1996:68-71.  Back to cited text no. 2    
3.Collee JG, Fraser AG, Marmion BP, Simmons A. In: Mackie and McCartney Practical Medical Microbiology, 14th ed, (Churchill Livingstone, London), 1996:385-404  Back to cited text no. 3    
4.Bauer AW, Kirby WMM. Antibiotic sensitivity testing by a standard disc diffusion method. Am J Clin Pathol 1960;45:493-496.  Back to cited text no. 4    
5.Caksen H, Oner AF, Arslan S, Koseoglu B, Harman M, Atas B, Abuhandan M. Splenic abscess, pleural effusion and sever anemia by Salmonella typhi. Kobe J Med Sci 2000;46(5):201-204.  Back to cited text no. 5    
6.Julia J, Canet JJ, Lacasa XM, Gonzalez G, Garau J. Spontaneous splenic rupture during typhoid fever. Int J Infect Dis 2000;4(2):108-109.  Back to cited text no. 6    
7.Giorgio A, Tarantino L, DeStefano G. Hepatic abscess caused by Salmonella typhi: diagnosis and management by percutaneous echo-guided needle aspiration. Ital J Gastroenterol 1996;28(1):31-33.  Back to cited text no. 7    
8.Sarma PS, Narula J. Multiple Salmonella typhi subcutaneous abscesses in a sickle cell anemia patient. J Assoc Physicians India 1996;44(8):563-564.  Back to cited text no. 8    
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2004 - Indian Journal of Medical Microbiology
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