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 ~  Abstract
 ~  Case Report
 ~  Discussion
 ~  References

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CASE REPORT
Year : 2004  |  Volume : 22  |  Issue : 2  |  Page : 128-129
 

Typhoid spine - A case report


Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai - 600 116, Tamil Nadu, India

Correspondence Address:
Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai - 600 116, Tamil Nadu, India

 ~ Abstract 

A case of Salmonella typhi isolated from L4-L5 spine is reported here. The causative organism was not suspected preoperatively. The patient responded favourably to surgical drainage and appropriate antibiotic therapy.

How to cite this article:
Rajesh P K, Mythili S, Subramaniam L. Typhoid spine - A case report. Indian J Med Microbiol 2004;22:128-9


How to cite this URL:
Rajesh P K, Mythili S, Subramaniam L. Typhoid spine - A case report. Indian J Med Microbiol [serial online] 2004 [cited 2019 Jun 15];22:128-9. Available from: http://www.ijmm.org/text.asp?2004/22/2/128/8088


 Salmonella More Details typhi, apart from presenting in its usual classical domain as an enteric pathogen, may present as localized infection at almost any site in the body. Recent reports have documented isolation of  S.typhi   from gluteal injection abscess,[1] cranial vault,[2] pancreatic abscess,[3] breast abscess[4] and liver abscess.[5] Here we present a case of S.typhi isolated from L4-L5 spinal vertebrae.

 ~ Case Report Top

A 38 year old lady presented with three months history of severe low backache with the pain radiating to the lower limbs. The patient also complained of low-grade fever. Skiagram and the magnetic resonance imaging (figure) revealed reduction in the height of L4 vertebral body and the joint space between L4-L5. Sclerotic areas in the intravertebral disc space and reduction in the height of L4-L5 body is observed in the posterior aspect. The magnetic resonance imaging also reveals an impression on the sub-arachnoid space at the level of L4-L5. The radiologists suggested infective pathology probably of tuberculous origin.
The patient was posted for surgery and preoperatively the pus was drained and sent for microbiological and pathological analysis. The Gram stain showed numerous polymorphs but no organisms were seen. Acid fast bacilli were also looked for and found negative. The pus was inoculated onto blood agar, MacConkey agar and Lowenstein Jensen medium. Non-lactose fermenting colonies were observed on the MacConkey agar after 24 hours incubation at 37C. Biochemical tests and agglutination with high titre sera confirmed the isolation of S.typhi.The isolate was sensitive to ampicillin, co-trimoxazole, chloramphenicol, tetracycline, cefuroxime, ciprofloxacin and ceftriaxone. The patient's blood culture was negative but the Widal test was positive at titres TO and TH >640. The patient was started on intravenous ceftriaxone and her condition improved dramatically.

 ~ Discussion Top

This patient gave a history of improperly treated enteric fever, six months prior to admission with low back pain. As the patient recalled being treated with ciprofloxacin for two to three days, the minimal inhibitory concentration of ciprofloxacin was determined and found to be 0.38g/mL (normal range).  Salmonella More Details osteomyelitis has been reported as early as 1957.[6] This article discussed the association of sickle cell anaemia with  Salmonella More Details osteomyelitis. However, our patient did not suffer from sickle cell disease. Pre-existing pathology makes the tissue vulnerable and provides a nidus for the bacteria to initiate a persistent infection.[4] Thus, follow-up of our patient only can confirm whether the pathology in her spine was caused due to S.typhi or whether S.typhi localized in an area of pre-existing abnormality.  Salmonella More Details vertebral osteomyelitis has been reported rarely and the most recent report is from Qatar in 1994.[7] 

 ~ References Top

1.Raghunath R, Ashok AC, Sridaran D, Indumathi VA, Belwadi MRS. A case of injection abscess due to Salmonella typhi. Indian J Med Microbiol 2003;21(1):59-60.  Back to cited text no. 1    
2.Thakur K, Singh DV, Goel A. Cranial Vault Salmonella Osteomyelitis leading to extradural abscess-A Case Report. Indian J Med Microbiol 2002;20(4):219-220.  Back to cited text no. 2    
3.Arya M, Arya PK. Pancreatic abscess caused by Salmonella typhi. Indian J Med Microbiol 2001;19(2):103-104.  Back to cited text no. 3    
4.Jayakumar K, Appalaraju B, Govindan VK. An Atypical presentation of Salmonella typhi - A Case Report. Indian J Med Microbiol 2003;21(3):211-212.  Back to cited text no. 4    
5.Navaneeth BV, Belwadi S, Harish V. Typhoid abscess in the liver. Indian J Med Microbiol 2000;18(2):83-84.  Back to cited text no. 5    
6.Silver HK, Simon JL, Clement DH. Salmonella osteomyelitis and abnormal hemoglobin disease. Pediatrics 1957;20(3):439-447.  Back to cited text no. 6    
7.Al Soub H, Uwaydah, Hussain AH. Vertebral osteomyelitis in Quatar. British J Clinical Practice 1994;48(3):130-132.  Back to cited text no. 7    
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2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

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