Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan

Abstract

BackgroundSalmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome.MethodsThe records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments.ResultsOf the twenty-four patients, seizures were noted in fifteen (63%) before admission and thirteen (54%) during hospitalization. Acute complications mainly included hydrocephalus (50%), subdural collection (42%), cerebral infarction (33%), ventriculitis (25%), empyema (13%), intracranial abscess (8%), and cranial nerve palsy (8%). Three patients (13%) died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%), motor disability (48%), intelligence quotient < 80 (43%), epilepsy (33%), sensorineural hearing loss (17%), visual deficits (10%), abducens nerve palsy (5%), microcephaly (5%), and hydrocephalus (5%). Overall, good outcome was noted in six (28.6%) of twenty-one survivors, mild sequelae in three (14.2%), moderate in six (28.6%), and severe in six (28.6%).ConclusionSalmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.

Salmonellosis beyond the gastrointestinal tract: a case series

“…In a study done in Kuala Lumpur by Lee et al on Salmonella meningitis in infants, 13 infants presented with fits and complications such as hydrocephalus, subdural effusions, empyema, ventriculitis, intracranial haemorrhage and cerebral abscess [4]. Overall mortality rate was 13%-18% [3,4]. The study further describes that relapses occurred due to inadequate treatment as might have happened in our cases as well.…”

“…Worldwide Salmonella meningitis remains a threat to children aged less than 2 years [3]. In a study done in Kuala Lumpur by Lee et al on Salmonella meningitis in infants, 13 infants presented with fits and complications such as hydrocephalus, subdural effusions, empyema, ventriculitis, intracranial haemorrhage and cerebral abscess [4].…”

Salmonella Meningitis: a Report from National Hue Central Hospital, Vietnam

“…Salmonella infection as a cause of bacterial meningitis is reported primarily in tropical areas (1,2), but also occasionally in industrialized countries (3)(4)(5). Most cases of Salmonella meningitis involve children less than 1 year of age, primarily less than 3 months old (3,4).…”

Recurrent meningitis due to Salmonella enteritidis: A case report from Kashmir India

“…[2,3] The incidence of salmonellosis is highest among children of 1-4 years of age and is associated with high morbidity and mortality. [4] Even if the meningitis is not fatal, sequelae such as epilepsy, cranial nerve palsies, and hydrocephalus can occur. Recurrence of bacterial meningitis in children is not only potentially life-threatening but also involves or induces psychological trauma to the patients through repeated hospitalization and multiple invasive investigations if the underlying cause remains undetected.…”