Renal involvement in prolonged salmonella bacteremia: the role of schistosomal glomerulopathy

Abstract

Renal involvement has been well documented in patients with hepatosplenic schistosomiasis and in patients with prolonged salmonella bacteremia (PSB). Whether there is a specific renal lesion related to PSB or the chronic bacterial infection aggravates a pre-existing schistosomal glomerulopathy has been a matter of controversy. To analyze the clinical manifestations and histopathological findings of the renal involvement, 8 patients with hepatosplenic schistosomiasis and PSB (group I) were compared with 8 patients with schistosomal glomerulopathy (group II) matched by sex and glomerular disease. The mean age in group I was 17.7 years. All patients presented with hematuria, in 4 cases associated with non-nephrotic proteinuria. In group II the mean age was 23 years; nephrotic syndrome was the clinical presentation in 7 of the 8 patients in the group. All patients in group I experienced remission of the clinical and laboratory abnormalities as the salmonella infection was cured; in group II the patients had persistent, steroid-resistant, nephrotic syndrome. On histological examination, no difference was noted between the two groups, except for pronounced glomerular hypercellularity and interstitial mononuclear cell infiltration in group I. These observations strongly suggest that PSB exacerbates a pre-existing sub-clinical schistosomal glomerulopathy by the addition of active lesions directly related to the prolonged bacteremia

Interaction between Salmonella and Schistosomiasis: A Review

“…One Brazilian study analyzed renal involvement of eight patients with hepatosplenic schistosomiasis and prolonged Salmonella infection compared to eight patients with schistosomal glomerulopathy (a reduction of the ability of the kidneys to flush out physiologic byproducts from the bloodstream). The authors found that prolonged Salmonella infection exacerbates pre-existing schistosomal glomerulopathy due to renal damage caused by the prolonged infection [44]. At least one other study has corroborated this finding: patients with coinfection of both Salmonella and schistosomiasis had a greater risk of developing glomerulonephritis, primarily due to Salmonella antigens [45].…”

The changing face of schistosomal glomerulopathy

“…Dual infection is well documented in the Egyptian medical literature [26]. Schistosomal salmonella infection, also observed in Brazil, induces a similar glomerular lesion [27]. Dual infection is not a simple coincidence; the bacteria live in symbiosis within the parasite's integument, taking advantage of the protective layer of the host's native proteins, which schistosomes use for evading the host's immune surveillance.…”

Chapter 9: Infection-related glomerulonephritis

“…Several studies have shown new-onset or worsening of nephrotic syndrome in the presence of coinfection with Salmonella . 442 …”

“…448 Other studies have shown disappearance of urinary abnormalities following anti- Salmonella therapy alone. 442, 444 The prognosis is relatively good with class I and II schistosomal GN, provided sustained eradication of Schistosoma and Salmonella infection can be achieved, whereas class IV and V lesions usually progress to ESRD despite treatment. 446, 449, 450 The association of Salmonella infection with schistosomal GN is not observed in all geographical areas.…”