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Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 113-114

Mixed salmonella infection - A case report

Dept. of Clinical Microbiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India

Correspondence Address:
Dept. of Clinical Microbiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India

 ~ Abstract 

Mixed infection with multiple Salmonella serotypes in the same patient is an unusual finding. We present a case of enteric fever in which the blood culture was sterile and Widal test was negative. The culture of the bone marrow yielded Salmonella typhi and Salmonella paratyphi A.

How to cite this article:
Joshi S, Wattal C, Sharma A, Prasad K J. Mixed salmonella infection - A case report. Indian J Med Microbiol 2002;20:113-4

How to cite this URL:
Joshi S, Wattal C, Sharma A, Prasad K J. Mixed salmonella infection - A case report. Indian J Med Microbiol [serial online] 2002 [cited 2021 Jan 16];20:113-4. Available from:

Enteric fever is endemic in India. A large number of cases are seen between June and October each year. Among the enteric fevers, typhoid fever is more common than paratyphoid fever. Bacteriologic confirmation of the diagnosis of enteric fever rests on the isolation of the pathogen from the patient's samples which include blood, bone marrow, stool, etc.[1],[2] We document a patient with mixed  Salmonella More Details infection.

 ~ Case Report Top

A 20 year old man was admitted to our hospital in October 2000 with complaints of intermittent high grade fever and dull aching pain in the right upper abdomen, with occasional vomiting, of five days duration, There was no past history of loose motions or jaundice. On examination, the patient was febrile (40C) and the pulse rate was 100/min. Liver was tender and palpable 3 cm below the right costal margin; spleen was firm and palpable 2 cm below the left costal margin. The systemic examination of chest, cardiovascular system and central nervous system was normal.
Investigations revealed a haemoglobin level of 14.7gm/dL, TLC was 10,000/mm3, and DLC showed P66L30M4. Peripheral smear did not reveal malarial parasites. Mantoux test was negative. Urine examination (routine and microscopic) was normal. Blood and urine cultures were sterile. Widal test was negative with titres less than 1:60 for TO, TH, AH and BH antibodies. X-ray chest and ultrasound of the abdomen did not reveal any abnormality except hepatosplenomegaly.
Since no cause for the fever could be ascertained, bone marrow aspiration was done. The aspirate was subjected to culture in Tryptose Soya broth. After overnight incubation at 37C, subculture on blood and MacConkey agar plates showed growth of two kinds of non lactose fermenting colonies on both the plates. The larger colony was identified as  Salmonella More Details typhi and the smaller one as  Salmonella More Details paratyphi A, using standard biochemical tests1 and agglutination with  Salmonella More Details antisera (Murex Biotech).
The sensitivity pattern by disc diffusion test showed that S. typhi was resistant to amoxycillin, chloramphenicol, co-amoxyclav, and co-trimoxazole and sensitive to amikacin, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin and netilmicin. The S. paratyphi A isolate was sensitive to all the antibiotics tested. The patient was treated with oral ofloxacin (400 mg twice daily) for 10 days and was asymptomatic on follow up.

 ~ Discussion Top

Enteric fever is a common cause of morbidity in India and S.typhi accounts for the majority of the infections. S. paratyphi A is less common but has shown a rising trend over the past five years whereas S. paratyphi B is rarer. Bone marrow cultures are more sensitive than blood cultures, in the diagnosis of enteric fever,[2] as was the case in our patient. The Widal test was negative which could be due to the short duration of infection and early initiation of antibiotic therapy.
Presence of simultaneous infection with different  Salmonella More Details serotypes in the same patient, proven on culture, is an unusual finding. Devi et al[3] have earlier reported double  Salmonella More Details infection with S. typhi and S. paratyphi A in the same patient. Ambartsumov et al[4] have also reported dual  Salmonella More Details infection in one patient. There have been reports of other concurrent infections along with enteric fever. Gopinath et al5 reported two cases of falciparum malaria and concomitant  Salmonella More Details bacteraemia. Association of  Salmonella More Details is also known.[6] One must be aware of the possibility of multiple  Salmonella More Details infections in the same patients, especially in an endemic zone. 

 ~ References Top

1.Kelly MT, Brenner DJ, Farmer JJ. Enterobacteriaceae. In: Manual of Clinical Microbiology. 4th ed. Lennette EH, Balows A, Hausler WJ, Shadomy JH., Eds (American Society of Microbiology, Washington, DC) 1985:263-277.  Back to cited text no. 1    
2.Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB. Relative efficacy of blood, urine, rectal swab, bone marrow, and rose-spot cultures for recovery of Salmonella typhi in typhoid fever. Lancet 1975; 1:1211-1213.  Back to cited text no. 2    
3.Devi JN, Rao PV, Shivananda PG. Enteric fever due to double Salmonella serotypes Indian J Pathol Microbiol 1986; 2:209-210.  Back to cited text no. 3    
4.Ambartsumov SM, Lerenman Mia. A combination of typhus abdominalis and paratyphus B in the same patient. Sov Med 1969; 32:71-75.  Back to cited text no. 4    
5.Gopinath R, Keystone JS, Kain KC. Concurrent falciparum malaria and Salmonella bacteraemia in travellers: report of two cases. Clin Infect Dis 1995; 20:706-708.  Back to cited text no. 5    
6.Penaud A, Nocurrit J, Chapoy P, Allessandrini P, Louchet E, Nicoli RM. Bacterioparasitic interactions. Enterobacteria and schistosomes (Salmonella-Schistosome association.) Med Trop (Mars) 1983; 43:331-340.  Back to cited text no. 6    
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