Brain abscess and epidural empyema caused by Salmonella enteritidisin a child: successful treatment with ciprofloxacin: a case report

Abstract

Focal intracranial infections caused by Salmonella are rare, especially those produced by S. enteritidis. We describe the case of a 26-month-old girl who underwent surgery for a frontoparietal ependymoma and presented with epidural empyema and a brain abscess due to S. enteritidis following an episode of gastroenteritis. The child was successfully treated by surgical drainage along with 9 weeks of antibiotic therapy including ciprofloxacin.

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“…The recommended duration of antibiotic treatment is 4 to 6 weeks or longer, with clinical and radiological monitoring. 3,5 Conflict of interest: we have no conflict of interest.…”

“…Salmonella has a tendency to infect diseased tissue, and a variety of predisposing factors have been described for brain abscess. 3 These include patients with primary or metastatic brain tumors, subarachnoid hemorrhage, corticosteroid use, diabetes mellitus, immunoglobulin deficiencies, HIV infection, and meningitis. Meningitis is the most important predisposing factor to focal intracranial infection by Salmonella.…”

“…Meningitis is the most important predisposing factor to focal intracranial infection by Salmonella. 3,4 Brain abscesses due to Salmonella spp, including S. enteritidis, have previously been reported and are usually assumed following bacteremia in the presence of some compromise of the reticulo-endothelial system (RES) immunity. Beta-thalassemia and sickle cell disease (SCD) are known to lead to RES compromise.…”

“…5 Mahapatra et al 6 in a review of cases of focal intracranial Salmonella infections in the world literature between 1884 and 2001, reviewed 80 reported cases of focal intracranial Salmonella infections, of which 22 were brain abscesses, 40 subdural empyemas and 18 were combinations of abscesses, empyemas, and epidural abscesses. 3,5,6 According to them, brain abscesses were common in adults and subdural empyemas more frequent in children. In general, their prognosis is poor with a mortality rate as high as 21-60% described in some patient series and a significant number of survivors developed permanent neurological sequelae.…”

“…3,5 Third-generation cephalosporins are the most sensitive agents to treat Salmonella CNS infections because they achieve high brain tissue concentrations. The recommended duration of antibiotic treatment is 4 to 6 weeks or longer, with clinical and radiological monitoring.…”