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Year : 2015  |  Volume : 33  |  Issue : 3  |  Page : 453--454

Wound infection by Salmonella Typhi in a spinal injury patient without underlying osteomyelitis

N Rajkumari1, P Mathur1, K Farooque2, V Sharma2,  
1 Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
2 Department of Orthopedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
P Mathur
Department of Laboratory Medicine, Microbiology Division, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi
India

How to cite this article:
Rajkumari N, Mathur P, Farooque K, Sharma V. Wound infection by Salmonella Typhi in a spinal injury patient without underlying osteomyelitis.Indian J Med Microbiol 2015;33:453-454

How to cite this URL:
Rajkumari N, Mathur P, Farooque K, Sharma V. Wound infection by Salmonella Typhi in a spinal injury patient without underlying osteomyelitis. Indian J Med Microbiol [serial online] 2015 [cited 2020 Jan 29 ];33:453-454
Available from: http://www.ijmm.org/text.asp?2015/33/3/453/158597

Full Text

Dear Editor,

Salmonella Typhi, which is endemic in India, has been known to cause varied diseases ranging from enteric fever, food poisoning to osteomyelitis. [1] There have been occasional reports on the occurrence of abscesses due to Salmonella sp. in liver, spleen and anterior abdominal wall. [2] Isolated cases of wound infection in normal patients in the absence of bacteraemia is extremely rare. We are describing a rare case of infection by Salmonella Typhi in the wound of a spinal injury patient.

A 20-year-old Asian male, migrant labourer, weighing 50 kg with history of fall from height presented with severe middle and lower back pain and inability to move his lower limbs for 4 days with no significant history of injury on admission. The patient was immunocompetent patient and not on steroids therapy. An examination revealed paraparesis but no bowel or bladder involvement. His Glasgow coma scale was 4/5/6 (15) at the time of admission. The patient was afebrile at the time of admission with normal vitals. There was no organomegaly or lymphadenopathy. His X-ray spine and magnetic resonance imaging (MRI) spine showed fracture dislocation of the lower D2-L1 without osteomyelitis. On routine work-up, his haemogram, liver function test (LFT), kidney function test (KFT), electrocardiogram (ECG) and chest X-ray were within normal limits. The patient started having fever after 3 days of admission with daily spikes continuously for 6 days, followed by a normal phase and then spikes of fever for 6 days intermittently. However, the patient had to undergo posterior thoracolumbar decompression and implantation surgical procedures for his spinal injury due to compressive paraparesis. Even in the post-operative period, the patient had high-grade fever with a peak of 40.5°C. The patient's blood was tested for malaria using the card test for Plasmodium vivax and P. falciparium which were negative. Wound swabs send from the injury site pre-operatively repeatedly isolated Salmonella enterica serotype Typhi sensitive to ampicillin, ceftriaxone ciprofloxacin (MIC ≤ 0.25), trimethoprim/sulfamethoxazole (MIC ≤ 20). The patient's blood culture was sterile throughout. The patient's wound was re-explored surgically and a repeat wound sample sent from the operation theatre again grew S Typhi. Serum samples sent for Widal test and Typhidot were negative in both. The His urine and stool cultures were negative for Salmonella Typhi at the time of admission and during the hospital stay. Sickle cell anaemia was ruled out by haemoglobin electrophoresis test.

He was treated with ceftriaxone, 1g intravenous (IV) twice daily along with ciprofloxacin, 500 g IV twice daily and antipyretics. Repeat wound swabs were sterile after 1 week. The patient was followed for 6 months in the out-patient department and no recurrence was seen and wound was healthy.

Isolated infection of wounds in spinal injury patient is a rare manifestation in such conditions, especially in the absence of underlying osteomyelities. Less than 1% of salmonella infections involves bones and joints, and usually ensues in patients with sickle-cell haemoglobinopathies, systemic lupus erythematosis, or in receipt of immunosuppressive therapy. [2] Osteomyelitis in sickle cell patients is a rare presentation. [3] A report of co-infection of Salmonella Typhi and P. falciparum in a girl having haemoglobin E trait has been reported from Bangladesh. [4] In our patient, we can only speculate that the patient might have been in a prodromal phase of enteric fever at the time of admission, the organism then localising into an abscess.

References

1Thakur K, Singh G, Gupta P, Chauhan S, Jaryal SC. Primary anterior parietal wall abscess due to Salmonella Typhi. Braz J Infect Dis 2010;14:328-9.
2Hook EW. Salmonella species (including typhoid fever). In: Mandell, Douglas and Bennett′s Principles and Practice of Infectious Disease. 7 th ed. Mandell GL, Bennett JE, Dolin R, editors. Churchill Livingstone Elsevier, Philadelphia, PA, USA; 2010:1700-10.
3Millet A, Hullo E, Armari Alla C, Bost-Bru C, Durand C, Nuques F, et al. Sickle cell disease and invasive osteoarticular Salmonella infections. Arch Pediatr 2012;19:267-70.
4Chowdhury F, Chisti MJ, Khan AH, Chowdhury MA, Pietroni MA. Salmonella Typhi and Plasmodium falciparium co-infection in a 12-year old girl with haemoglobin E trait from a non-malarious area in Bangladesh. J Health Popul Nutr 2010;28:529-31.