Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 633 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
 ~ Next article
 ~ Previous article 
 ~ Table of Contents
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (15 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  References

 Article Access Statistics
    Viewed6083    
    Printed136    
    Emailed7    
    PDF Downloaded187    
    Comments [Add]    
    Cited by others 6    

Recommend this journal

 


 
CORRESPONDENCE
Year : 2005  |  Volume : 23  |  Issue : 1  |  Page : 66-67
 

Neonatal septic arthritis due to Salmonella typhimurium


Department of Microbiology, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad - 500 082, AP, India

Date of Submission27-Jun-2004
Date of Acceptance26-Jul-2004

Correspondence Address:
P Sarguna
Department of Microbiology, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad - 500 082, AP
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.13880

Rights and Permissions



How to cite this article:
Sarguna P, Lakshmi V. Neonatal septic arthritis due to Salmonella typhimurium. Indian J Med Microbiol 2005;23:66-7

How to cite this URL:
Sarguna P, Lakshmi V. Neonatal septic arthritis due to Salmonella typhimurium. Indian J Med Microbiol [serial online] 2005 [cited 2019 Aug 25];23:66-7. Available from: http://www.ijmm.org/text.asp?2005/23/1/66/13880


Dear Editor,

 Salmonella More Details infection is endemic in developing countries. Isolation of Salmonella species from aberrant sites with variety of clinical syndromes, where they are hardly expected, has been reported.[1] Septic arthritis and osteomyelitis are uncommon due to this organism, compared to other gram negative bacteria. They are usually associated with underlying disease including haemoglobinopathies, previous joint trauma, surgery, connective tissue diseases, lymphoma or immunosuppressive state.[2],[3],[4],[5] Arthritis usually involves large joints such as hip, knee, ankle and shoulder.[2] S.choleraesuis,  S.typhi Scientific Name Search murium[3] and S. enteritidis[4] have a high arthritogenic potential. We report this case of septic arthritis of left knee joint caused by S.typhimurium in a neonate.

A 15-day-old male neonate, with a history of full term normal institutional delivery, diagnosed to have a patent ductus arteriosus, was admitted in our institute with complaints of fever and swelling of left knee since one week. There was no history of trauma of any kind. On examination, the swelling was soft, fluctuating, painful, tender with increased local temperature and restricted movements. A provisional diagnosis of septic arthritis of left knee with septicaemia with patent ductus arteriosus with congestive heart failure was made.

All the vital parameters and peripheral blood picture were within normal limits, except for a low haemoglobin percentage of 6.2 gm%. With the clinical suspicion of septic arthritis of the knee joint, the synovial fluid was aspirated from the joint and sent for microbiological evaluation. A Gram stained smear of the purulent synovial fluid showed plenty of polymorphonuclear cells and gram negative bacilli.

The synovial fluid was inoculated onto blood agar, MacConkey agar, Lowenstein Jensen medium and Sabouraud dextrose agar (SDA). Lactose fermenting and non-lactose fermenting colonies were observed on MacConkey agar after 24 hours incubation at 37C. Biochemical tests confirmed the isolation of Klebsiella pneumoniae Scientific Name Search  and Salmonella spp. The Salmonella isolate was sent for confirmation and serotyping to National Salmonella and  Escherichia More Details reference centre, Kasuali, Himachal Pradesh, India. It was identified as S.typhimurim 4, 5 12:i:1,2. The isolate was sensitive to ciprofloxacin and norfloxacin with resistance to third generation cephalosporins, aminoglycosides, ampicillin, chloramphenicol and co-trimonazole. No Mycobacterium or fungus was isolated. Blood culture was sterile and Widal test did not show any diagnostic titre.

The patient was started on intravenous cefotaxime and metronidazole before the culture result was available. Arthrocentesis was done. On postoperative follow up, active movements were elicited, on stimulation showing a clinical improvement. The patient was treated for a week and was discharged. S.choleraesuis and S.typhimurium are the most commonly reported strains causing arthritis.[3],[4] The joint aspirate culture yielded S.typhimurium along with K.pneumoniae, the most important causative organisms of septic arthritis in infants.[1] Synovial fluid gram stained smears have been reported to be positive in two-thirds of the cases.[5] Salmonella has been isolated from blood in 65% of cases.[2] The combination of blood culture and joint aspirate culture results in very high rate (72%) of bacterial isolation. In this case, the blood culture was sterile probably because the patient was on prior antibiotic therapy.

Two to four weeks of appropriate intravenous antibiotics and repeated arthrocentesis result in good clinical outcome in most cases of Salmonella septic arthritis. Surgical drainage is indicated only in cases with inadequate aspirations. To conclude, where enteric infections with Salmonella are endemic, bacteraemia could occur in immunosupressed individuals or in children with congenital disease in whom the infection has a tendency to spread haematogenously to the larger joint metaphysis which is one of the most commonly affected sites.[3] S.typhimurium being invasive, should be added to the spectrum of potential list of pathogen that cause septic arthritis in immunosuppressed state.[3]

 
 ~ References Top

1.Leela Naidu PS, Satyavati S. Salmonella species at aberrant sites. A review. Ind J Med Sci 1974;28:149-151.  Back to cited text no. 1    
2.Cohen JI, Barlett JA, Cory GR. Extra-Intestinal manifestations of Salmonella infections. Medicine 1987;66:349-388.  Back to cited text no. 2    
3.Lesser CF, Miller SI. Salmonellosis, Chapter 156. In:Harrison's Principles of Internal Medicine, 14 ed. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Eds (McGraw - Hill, New York) 2001 Vol I:970-975.  Back to cited text no. 3    
4.John R, Mathai D, Daniel AJ, Lalitha MK. Bilateral septic arthritis due to Salmonella enteritidis. Diagnostic Microbiology and Infectious Diseases 1993;17(2):167-169.  Back to cited text no. 4    
5.Worawit L. Salmonella septic arthritis in patients with human immunodeficiency virus infection. The Journal of Rheumatology 1993;28:1454-1455.  Back to cited text no. 5    



This article has been cited by
1 Salmonella-Salmonellosis-Rare presentations of a common pathogen
Neelam Kaistha, Varsha Gupta, Shailpreet Sidhu, Jagdish Chander
Asian Pacific Journal of Tropical Medicine. 2011; 4(5): 417
[VIEW] | [DOI]
2 Neonatal salmonella | [Neonatale salmonelleninfektion]
Fischer, E., Reese, J.
Gynakologische Praxis. 2010; 34(2): 245-251
[Pubmed]
3 Unusual clinical presentation of bone and joint infections caused by Salmonella typhi
Gupta, V., Kaur, J., Gupta, R., Gupta, P., Chander, J.
Journal of Pediatric Infectious Diseases. 2010; 5(1): 103-106
[Pubmed]
4 Septic Arthritis of Hip in a Neutropenic Child Caused by Salmonella typhi
Rahul Naithani,Sanjay Rai,Ved P. Choudhry
Journal of Pediatric Hematology/Oncology. 2008; 30(2): 182
[Pubmed] | [DOI]
5 Septic arthritis of hip in a neutropenic child caused by salmonella typhi
Naithani, R., Rai, S., Choudhry, V.P.
Journal of Pediatric Hematology/Oncology. 2008; 30(2): 182-184
[Pubmed]
6 Neonatal salmonella infection | [Neonatale Salmonelleninfektion
Fischer, E., Reese, J.
Padiatrische Praxis. 2006; 69(1): 1-7
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04