Fatal Case of Salmonella enterica subsp. arizonae Gastroenteritis in an Infant with Microcephaly

Abstract

Salmonella enterica subsp. arizonae is a common gut inhabitant of reptiles, with snakes as the most common reservoir. Though human cases due to this organism are exceedingly rare, it may infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Gastroenteritis is the most common presentation; others include peritonitis, pleuritis, osteomyelitis, meningitis, and bacteremia. We report a fatal case of S. enterica subsp. arizonae gastroenteritis in a 3-month-old child with microcephaly, with a review of earlier cases and problems encountered in identification of this rare human pathogen. CASE REPORTA 3-month-old female child presented to the Emergency Unit at Ram Manohar Lohia Hospital, New Delhi, India, with a history of fever and cough for 20 days and diarrhea with mucus and blood for 15 days. There was no history of similar illness in other family members or in the community. On admission, the child, who had microcephaly, appeared highly irritable and had tachypnea and bilateral crepitations. The spleen and liver were just palpable, and there was a rash all over the body. The patient was diagnosed as having pneumonia with persistent diarrhea. A fecal sample was sent for routine culture and microscopic examination, and the patient was empirically started on broad-spectrum antibiotics (ampicillin, cefotaxime, and amikacin). Investigations revealed a hemoglobin level of 11.0 g%, a total leucocyte count of 11,500/ml, and an erythrocyte sedimentation rate of 100. A urine culture was sterile, and cerebrospinal fluid biochemistry and cytology showed no abnormality. The chest X ray showed infiltration in both lungs, while the skull X ray was normal.The routine microscopic examination of feces did not reveal the presence of any protozoan or helminth. While fecal cultures grew a non-lactose-fermenting motile organism, the routine biochemical tests (indole, triple-sugar iron agar, citrate, urea, mannitol, and motility) for this isolate were obfuscating.

Detection and characterization of virulence factors in lactose positive and lactose negative Salmonella serovars isolated from seafood

“…Outbreaks of disease from lac + Salmonella has been reported previously (Camara, Cardoso, & de Almeido, 1989;Dube, 1983;Falcao, Trabulsi, Hickman, & Farmer, 1975;Ruiz, Núñez, Sempere, Díaz, & Gómez, 1995). In India, Salmonella arizonae (IIIa) infection in infants and children has been reported by Mahajan et al (2003).…”

Comparative Genetics of the rdar Morphotype inSalmonella

“…One of the major differences from other Salmonella groups is that S. enterica subsp. arizonae isolates are common gut inhabitants of reptiles and snakes and could be part of the commensal microflora in these animals (40). Thus, S. enterica arizonae isolates are known to cause disease primarily in patients who are immunocompromised (40).…”

Salmonellaserovar distribution in cobras (Naja kaouthia), snake-food species, and farm workers at Queen Saovabha Snake Park, Thailand

“…26,27 Recently, reptile-associated salmonellosis has been reported in European countries, the United States, and Australia, where serovars Enteritidis, Typhimurium, Urbana, and Rubislaw, and Salmonella subspecies IIIa, subspecies IIIb (diarizonae), and subspecies IV (houtenae) were frequently obtained from patients with watery diarrhea and extra-gastrointestinal infection such as pleuritis, lymphadenitis, arthritis, meningitis, and cystitis, particularly in infants and immunocompromised hosts. 16,21,23 Transmission of Salmonella spp. from pet reptiles to human beings could occur from direct contact and inappropriate hygiene by the owner after touching the pets.…”