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Year : 2003  |  Volume : 21  |  Issue : 3  |  Page : 211--212

An atypical presentation of salmonella typhi - A case report

K Jayakumar1, B Appalaraju1, VK Govindan2,  
1 Departments of Microbiology, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu, India
2 Departments of Surgery, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu, India

Correspondence Address:
K Jayakumar
PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu
India

Abstract

Breast abscess due to Salmonella typhi is an extremely rare occurrence. A lady with a lump in the left breast was diagnosed to have a fibroadenoma and was subjected to a surgical procedure. She was found to have an abscess due to Salmonella typhi as confirmed by conventional bacteriological methods. She was treated with ciprofloxacin and responded favourably.

How to cite this article:
Jayakumar K, Appalaraju B, Govindan V K. An atypical presentation of salmonella typhi - A case report.Indian J Med Microbiol 2003;21:211-212

How to cite this URL:
Jayakumar K, Appalaraju B, Govindan V K. An atypical presentation of salmonella typhi - A case report. Indian J Med Microbiol [serial online] 2003 [cited 2020 Aug 10 ];21:211-212
Available from: http://www.ijmm.org/text.asp?2003/21/3/211/8022

Full Text

The clinical features of enteric fever include prolonged fever, bacteraemia, involvement of reticuloendothelial system, and dissemination to multiple regions. We present a case who had an atypical presentation with Salmonella typhi. This is encountered in all parts of the world and is rarely associated with abscess formation. Occasionally Salmonella spp. are associated with abscesses in the pancreas,[1] injection site,[2] gall bladder and spleen.[3] Osteomyelitis, lung abscess[4] and pelvic abscess[5] have been reported. To the best of our knowledge, S.typhi causing breast abscess has been reported only decades ago once in the past in the English literature.[6]

 Case Report



A forty year old lady presented with a lump in the left breast of two months duration to the surgery out patient department. She was diagnosed clinically to have a fibroadenoma. The excision biopsy proved that there was localized pus in the breast which was sent for bacteriological culture. The sample was processed as per standard protocols[7] which yielded non lactose fermenting colonies with typical biochemical reactions, motility and gram reactions. Further confirmation was done by agglutination test with specific antisera and the organism was identified as S.typhi. The isolate was sensitive to chloramphenical, cephotaxime, ciprofloxacin, ampicillin, cotrimoxazole and ceftrioxone. A retrospective blood culture was done which was found to be negative but the Widal test showed a positive result with the titre of TO 640 and TH 320. Stool culture was found positive for S.typhi.

A repeat sample from the breast abscess yielded the same isolate. The patient was started on intravenous ciprofloxacin and later switched over to oral therapy to which she responded favourably with regression of the lesion. The stool culture was repeated during the subsequent visit of the patient. It had become negative following the effective antimicrobial therapy.

 Discussion



Bacteraemia is a constant feature of enteric fever, which is usually caused by S.typhi, and its dissemination may lead to localized foci of infection especially when there is a pre existing abnormality, as in our patient who presented with a fibroadenoma of the breast. Preexisting pathology makes the tissue vulnerable and provides a nidus for the bacteria to initiate a persistent infection.

It is a reminder to the diagnosticians, that while we have several emerging new infections, the older diseases have newer presentations. Microbiological evaluation of a properly obtained specimen is mandatory in such unusual pyogenic infections.

References

1Arya M, Arya PK. Pancreatic abscess caused by S.typhi. Indian J Med Microbiol 2001;19(2):103-104.
2Raghunatha R, Ashok AC, Sridaran D, Indumathi VA, Belwadi MRS. A case of injection abscess due to S.typhi. Indian J Med Microbiol 2003;21(1):59-60.
3Sinha S, Sharma DC, Miri B, Gupta V, Chattopadhyay TK. Splenic abscess- Case report and review of literature. Trop Gastroenterol 1997;18(3):134-135.
4Ridha AG, Malbrain ML, Mareels J, Verbraeken H, Zachee P. Lung abscess due to nontyphoid Salmonella in immunocompromised host: Case report with review of the literature. Acta Clin Belg 1996;51(3):175-183.
5Hung TH, Jeng CJ, Su SC, Wang KG. Pelvic abscess caused by Salmonella - a case report. Chung Hua Hsueh Tsa Chih (Taipei) 1996;57(6):457-459.
6Barrett GS, MacDermot J. Breast abscess: a rare presentation of typhoid. British Med J 1972;2:628-629.
7Colle J G, Fraser AG, Marmin BP, Simmons A. Mackie And Mccartney Practical Medical Microbiology - 14th Edition (Churchill Livingstone, London) 1996;385-404.