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 ~  Abstract
 ~  Introduction
 ~  Case Report
 ~  Discussion
 ~  References

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CASE REPORT
Year : 2009  |  Volume : 27  |  Issue : 4  |  Page : 365-367
 

Salmonella enterica serotype dublin bacteraemia mimicking enteric fever


Department of Microbiology, Father Muller Medical College, Mangalore - 575 002, Karnatak, India

Date of Submission25-Sep-2008
Date of Acceptance06-Mar-2009
Date of Web Publication4-Sep-2009

Correspondence Address:
B Antony
Department of Microbiology, Father Muller Medical College, Mangalore - 575 002, Karnatak
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.55463

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 ~ Abstract 

Salmonella enterica serotype Dublin, a bovine adapted serotype, is the commonest cause of salmonellosis in cattle. Salmonellosis in animals always presents a potential zoonotic threat. Infected cattles serves as a source of infection to humans. We present here Salmonella Dublin Bacteraemia in an elderly patient, with all the clinical details, due to the rarity of its occurrence. He was treated successfully with ciprofloxacin and his follow up period was uneventful.


Keywords: Bacteraemia, S. Dublin


How to cite this article:
Dias M, Antony B, Pinto H, Rekha B. Salmonella enterica serotype dublin bacteraemia mimicking enteric fever. Indian J Med Microbiol 2009;27:365-7

How to cite this URL:
Dias M, Antony B, Pinto H, Rekha B. Salmonella enterica serotype dublin bacteraemia mimicking enteric fever. Indian J Med Microbiol [serial online] 2009 [cited 2019 Jul 17];27:365-7. Available from: http://www.ijmm.org/text.asp?2009/27/4/365/55463



 ~ Introduction Top


 Salmonella More Details are effective commensals and pathogens that cause a spectrum of disease in humans and animals including reptiles, birds and insects. Non typhoidal salmonellae are primary pathogens of lower animals.Infected animals are often asymptomatic. Salmonellae can be isolated from the intestinal tracts of humans and lower animals. They are the significant source of nontyphoidal  Salmonellosis More Details in humans. Some salmonella serotypes such as Dublin (cattle) and Arizonae (reptiles) are normally adapted to an animal species and only occasionally infect humans. [1]

Among non typhoidal Salmonellae, S.Dublin and S.Cholerasuis have a greater propensity to rapidly invade the blood stream with little or no intestinal involvement. [2] We report here a case of Salmonella Dublin Bacteraemia mimicking enteric fever


 ~ Case Report Top


A 73 year old man with a history of fever with chills and watery stools since three months was admitted in the medicine ward of a tertiary care hospital, Mangalore. There was no history of diabetes and hypertension. He was a non alcoholic and non smoker. On examination, he had high fever of 103 0 F and his blood pressure read 120/80 mm of Hg. His respiratory system, cardiovascular system and central nervous system were normal. Per abdomen examination showed soft, non tender hepatosplenomegaly. Laboratory investigations revealed Haemoglobin 11.3 gm/dl, total leucocyte count 19,000/cumm with neutrophils-77%, leukocytes-20% and eosinophils-03% and ESR-103mm at the end of 1 st hour, blood urea 34 mg/dl, serum creatinine 1.2 mg/dl. The other biochemical parameters including liver function tests were within normal limits. Sputum was negative for acid fast bacilli. Blood sample tested for HIV, HBsAg and malarial parasites were found negative. Ultrasonography of abdomen showed chronic parenchymal liver disease with splenomegaly.

X-ray of the chest and Echocardiogram were normal. Widal test was positive only for  Salmonella typhi Scientific Name Search tibodies with a titre of 1:360.

Bacteriological Examination

Blood collected on the day of admission and sent for culture yielded a pure growth of non lactose fermenting colonies on MacConkey's medium, which were motile, gram negative bacilli exhibiting the following biochemical reactions - glucose, mannitol, Dulcitol were fermented with acid and gas,lactose and sucrose were not fermented. It produced H 2 S. Urease was not hydrolysed and indole was not produced. This isolate agglutinated only with the salmonella poly O (A-G) antisera (Remel Europe limited) by slide agglutination. The bacteria was sensitive to ampicillin, gentamicin, amikacin, ciprofloxacin, Ofloxacin, chloramphenicol, cotrimoxazole, nalidixicacid, cefotaxime, ceftriaxone. This serotype was identified as non typhoidal salmonella. It was confirmed as Salmonella enterica serotype Dublin (9,12; g:p) by the National centre for Salmonella and Escheriachia coli, Central Research Institute, Kasauli (H.P). Stool and urine culture for Salmonella were negative.

The patient was started on I.V ciprofloxacin infusion 500 mg bd on the day of admission. Based on the antibiogram, the same treatment was continued for 10 days. The patient recovered from the illness and was discharged on the 10 th day of admission when his general condition improved. His follow up period was uneventful.


 ~ Discussion Top


The recent years have witnessed an increased rate of infection with non typhoidal Salmonellosis due to change in food consumption and the rapid growth of international trade in food products. Salmonella enterica serotype Dublin is mainly a veterinary pathogen and rarely causes human illness. Though reports on the prevalence of this serotype of Salmonella isolated in different countries are available, [3],[4],[5],[6],[7] such information from India appears to be lacking. Our limited review of literature showed only one reported case of S. Dublin meningitis from India, in a child in the year 1977. [8] In a recent study conducted in Mumbai, Salmonella Dublin was isolated from sprouted Moong [9] which is an alarming finding as human and animal faeces may contaminate the surface of the fruits and vegetables and may not be removed by washing. It is reported that seeds soaked in 20,000 ppm calcium hypochlorite can reduce the risk of sprout associated illness to a certain extent. [10]

Salmonella Dublin , a bovine adapted serotype, is considered to be the most common cause of Salmonella infection in cattle. Infected cattle serves as the source of infection and transmission usually occurs from eating beef, cheese and drinking raw milk. [5],[6],[7] Raw or inadequately pasteruised milk is increasingly recognized as a potential vehicle of Salmonella infection especially S.Dublin , Our patient must have contracted the disease from cattle or by consuming cow's milk and its products since he is a farmer by occupation.

Normally, non typhoidal Salmonella infection does not extend beyond the lamina propria and the local lymphatics. S.Dublin and S.Cholerasuis rapidly invade the bloodstream with little or no intestinal involvement. Specific virulence genes are related to the ability to cause bacteraemia. [2] Salmonella Dublin is known to cause high incidence of invasive disease with extra intestinal involvement as implied in the literature. [2],[5] In our case, the patient had bacteraemia mimicking enteric fever and the isolation was possible only from blood sample.

Salmonella Dublin has a predilection to persons with old age and underlying debilitating disorders. [1],[2],[5] In most of the reported cases, infection is seen in extremes of age [4],[5],[8] In this report also the infected person was 73 years old.This bacterium is reported to exhibit low levels of single antimicrobial resistance. [4] Our isolate was sensitive to all the microbial agents routinely employed for treatment.

Cattle rearing is one of the major occupations in rural India. The transmission of S.Dublin infection is through raw milk and its products, a well known fact.Hence stringent steps should be taken to prevent the transmission of infection to humans by controlling the infection in animal reservoirs, prevention of contamination of foodstuffs and use of appropriate standards in food processing. Microbiologists should make an attempt to identify all the Salmonella isolates to serotype level. There is an urgent need for a regular monitoring system before the emerging zoonotic pathogen becomes a potential public health hazard.

 
 ~ References Top

1.Pegues DA, Ohl ME, Miller SI. Salmonella Species Including Salmonella Typhi chapter 220. In: Mandell, Douglas, Bennett. editors. Principles and practice of Infectious Diseases. 6 th ed. Vol. 2. Philadelphia: Elsevier Churchill Livingstone; p. 2636-54.   Back to cited text no. 1    
2.Bhutta ZA. Salmonella chapter 195. In: Kliegman, Behrman, Jensen, Stanton, editors.Nelson Textbook of Pediatrics. 18 th ed. Vol .1. Philadelphia: Saunders; p. 1182-91.  Back to cited text no. 2    
3.Lawrie R. Robert, Salmonella Dublin as a cause of chronic osteomyelitis, J Bone Joint Surg Br 1952;34:80-81.  Back to cited text no. 3    
4.Jiménez-Sáenz M, Gómez-Rodriguez BJ, Carmona I, Rebollo J, Torres Y, Rodriguez-Baños J, et al . Salmonella dublin infection: A rare cause of spontaneous bacterial peritonitis and chronic colitis in alcoholic liver cirrhosis. Eur J Gastroenterol Hepatol 2001;13:587-9.  Back to cited text no. 4    
5.CDC.Salmonella Dublin and Raw Milk Consumption California. MMWR Morb Mortal Wkly Rep 1984;33:196-8.   Back to cited text no. 5    
6.Vaillant V, Haeghebaert S, Desenclos JC, Bouvet P, Grimont F, Grimont PA, et al . Outbreak of Salmonella dubin infection in France, November-December 1995. Euro Surveill 1996;1:9-10.   Back to cited text no. 6    
7.Allerberger F, Liesegang A, Grif K, Prager R, Danzl J, Hock F, et al . Occurrence of salmonella enterica Serovar Dublin in Austria. Euro surveill 2002:7 : 65-70.  Back to cited text no. 7    
8.Diwan N. Salmonella Dublin Meningitis. Report of a case. Indian J Paediatr 1997;44:110-1.  Back to cited text no. 8    
9.Saroj SD, Shashidhar R, Dhokane V, Hajare S, Sharma S, Bandekar JR. Microbiological evaluation of sprouts marketed in Mumbai, India and its suburbs. J Food Prot 2006;69:2515-8.  Back to cited text no. 9    
10.Brooks JT, Rowe SY, Shillam P, Heltzel DM, Hunter SB, Slutsker L, et al . Salmonella typhimurium infections transmitted by chlorine pretreated clover sprout seeds. Am J Epidemiol 2001;154:1020-8.  Back to cited text no. 10    




 

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