Nontyphoid Salmonella Bacteremia: Age‐Related Differences in Clinical Presentation, Bacteriology, and Outcome

Shimoni, Zvi; Pitlik, Silvio; Leibovici, Leonard; Samra, Zmira; Konigsberger, Hanna; Drucker, Moshe; Agmon, Vered; Ashkenazi, Shai; Weinberger, Miriam

doi:10.1086/515186

Cited by 165 publications

(148 citation statements)

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“…Salmonella is a well-recognized cause of endovascular infection in different anatomic sites, of which mycotic aneurysm of the aorta is considered to be the most frequent (13). Among patients above 50 years of age with non-serovar Typhi Salmonella bacteremia, 7 to 10% have been reported to develop arterial infection (2,5,12). In our patient, the muscular abscess most probably originated from an atherosclerotic plaque that had become infected during a transient bacteremic episode.…”

Section: Case Reportmentioning

confidence: 60%

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Björkman¹,

Nilsson²,

Riesbeck

2002

J Clin Microbiol

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Salmonella enterica serotype Brandenburg is one of the more uncommon serotypes isolated from patients with gastroenteritis. Few cases of extraintestinal infections with serotype Brandenburg have been documented. The first case of a serotype Brandenburg-dependent thigh abscess originating from an atherosclerotic pseudoaneurysm of the femoral artery is reported. CASE REPORTDuring a medium-distance flight, a 57-year-old male Caucasian pilot suddenly experienced sharp pain in his right thigh followed by fever. The patient had hypercholesterolemia and non-insulin-dependent diabetes mellitus regulated by diet. In addition, he had previously experienced mild claudicatio intermittens in his right leg and had thus been prescribed acetylsalicylic acid. On the following day, he was seen by his general physician, who found no signs of deep venous thrombosis and prescribed diclofenac for symptomatic relief. During the subsequent week, the thigh swelling increased and the fever persisted. Five days after the initial symptoms, a tender nonfluctuating mass measuring 10 by 15 cm was found in the right thigh adjacent to the groin. A fine-needle puncture of the mass yielded blood only. A week later, magnetic resonance tomography of the thigh showed an extensive swelling surrounded by soft-tissue edema ( Fig. 1A and B). A pseudoaneurysm of the right femoral artery with extensive collateral circulation was identified by intravenous angiography (Fig. 1C). Empirical antibiotic therapy with difloxacillin (750 mg three times orally) was initiated. However, the patient's condition deteriorated with expansion of the soft tissue mass and persistent fever. The patient was admitted to the hospital. On admission, the leukocyte count was 16.6 ϫ 10 9 /liter with a predominance of neutrophils, the erythrocyte sedimentation rate and C-reactive protein level were 84 mm/h and 160 mg/liter, respectively, and the hemoglobin level was 124 g/liter. Liver and renal function tests were normal. Therapy with intravenously administered cefuroxime was initiated, after which the fever disappeared; however, the soft tissue mass remained unchanged. Three weeks after onset of symptoms, an abscess in the thigh muscles with close connection to the femur was incised and drained of pus. The patient's condition improved rapidly after the surgical intervention. Culture of pus from the abscess revealed growth of Salmonella species strain O4. Bone scintigraphy showed no pathological uptake in the femur or elsewhere in the skeleton. The patient was treated with oral levofloxacin for 3 months with no signs of recurrent infection. Interestingly, 2 weeks prior to the onset of disease, our patient had been to Tunisia, where he had experienced transient gastrointestinal discomfort without diarrhea or fever.The bacterial organism was isolated from the abscess fluid after 4 days of incubation using aerobic flasks with liquid medium (BacT/Alert; Organon Teknika). The isolate was subcultured onto supplemented human blood agar plates containing Columbia II agar, L-cysteine, hemin,...

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Section: Case Reportmentioning

confidence: 60%

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Björkman¹,

Nilsson²,

Riesbeck

2002

J Clin Microbiol

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“…1 Annually, S. enterica alone causes an estimated 155,000 deaths worldwide and at least 350 deaths in the U.S.; it is responsible for up to 78% of NTS endocarditis cases and 57% of NTS pericarditis cases. 4,7 Despite increasing awareness of epidemic NTS and S. enterica infections, clinicians rarely consider them potential causes of endovascular and cardiac infections. Fever (100%), heart murmurs (57%), and heart failure (71.4%) are frequently observed in association with NTS endovascular infections, but antecedent diarrhea is rare.…”

Section: Discussionmentioning

confidence: 99%

“…33 Patients with SLE who have been treated with prednisolone, cyclophosphamide, azathioprine, or methotrexate are more predisposed to NTS septicemia and endocarditis than are patients who do not receive immunoregulatory medication. [6][7][8]33 Structural Heart Disease In the previously mentioned 1978 review, 10 83% of Salmonella endocarditis patients younger than age 50 had underlying valvular disease with predominantly mural (rather than valvular) lesions. In a more recent study, 85.7% of cardiovascular NTS patients had underlying heart conditions that included valve disease, prosthetic valves, and ventricular aneurysms.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

Nontyphoidal Cardiac Salmonellosis: Two Case Reports and a Review of the Literature

Ortiz

Siegal

Kramer

et al. 2014

Texas Heart Institute Journal

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1 Salmonella enteritidis is the most common serotype, presumably as a consequence of frequent chicken and egg contamination.1,2 Most cases of salmonellosis are limited to gastroenteritis, but bacteremia occurs in 3% to 8% of infections; cardiovascular infections, including pericarditis and endocarditis, develop in 1% to 5% of patients.3,4 The pathogenesis of cardiac salmonellosis is related to the quantity of bacteria ingested, the characteristic ability of Salmonella to adhere to damaged endothelium, the strength of the host's immune response, and the host's previous exposure. The sequelae of Salmonella endocarditis, including valve perforation, valve ring abscess, atrioventricular wall perforation, and cusp rupture, result in an estimated mortality rate of up to 75%. 5,6 Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment. Case Reports Patient 1A 73-year-old woman presented after 3 days of progressive nausea, diarrhea, fevers, and weakness. Her medical history was significant for asthma, hypertension, and replacements (4 years earlier) of both mechanical mitral and bioprosthetic aortic valves.The patient's initial temperature was 101 °F, her blood pressure was 59/31 mmHg, and her heart rate was 74 beats/min. An electrocardiogram (ECG) showed sinus rhythm. Her white blood cell count was 8,200 K/µL; blood urea-nitrogen level, 42 mg/dL; creatinine level, 2.04 mg/dL; and initial venous lactate level, 1.3 mmol/L. Urinalysis showed 26 to 100 white cells per high-power field, and a chest radiograph showed bilateral pulmonary infiltrates. She was stabilized, started on intravascular levofloxacin (0.75 mg/kg/d), and admitted to the intensive care unit, where she developed rigors and respiratory distress that necessitated endotracheal intubation and mechanical ventilation. A repeat ECG showed a new pattern of left bundle-branch block. An echocardiogram showed heavy mitral annular calcification, which produced a dense artifact around the sewing ring that suggested endocarditis.On the 2nd day of hospitalization, blood-culture results were positive for gramnegative rods. Transesophageal echocardiography revealed an aortic valve abscess and a 1.1 × 0.5-cm vegetation (with a central cavitation) on her mechanical mitral valve (Fig. 1). The presumed source of the endocarditis was the urinary tract infection,

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“…In their 11-year retrospective study of Salmonella focal infection, Rodrigues et al reported 85% of patients with Salmonella cystitis had concurrent diarrhoea, whereas all patients with Salmonella pyelonephritis had concurrent bacteraemia (2). In addition, adults are more likely to have primary bacteraemia and have a higher incidence of secondary focal infections (15).…”

Section: Discussionmentioning

confidence: 99%

Nontyphoidal Salmonella Urinary Tract Infection in a Case of Hyperparathyroidism and Nephrocalcinosis

Shi

et al. 2013

West Indian Med J

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Nontyphoidal Salmonella infections often present with self-limited gastroenteritis. Extraintestinal focal infections are uncommon but have high mortality and morbidity. Urinary tract infection caused by nontyphoidal RESUMEN Las infecciones por Salmonella no tifoidea se presentan a menudo con gastroenteritis auto-limitada. Las infecciones extra-intestinales focales son poco frecuentes, pero tienen una alta mortalidad y morbilidad. La infección de las vías urinarias causada por la

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Nontyphoid Salmonella Bacteremia: Age‐Related Differences in Clinical Presentation, Bacteriology, and Outcome

Cited by 165 publications

References 1 publication

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Nontyphoidal Cardiac Salmonellosis: Two Case Reports and a Review of the Literature

Nontyphoidal Salmonella Urinary Tract Infection in a Case of Hyperparathyroidism and Nephrocalcinosis

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