Salmonella enteritidis causing brain abscess and coxitis following intracranial surgery

Abstract

We report the case of a 46-year-old woman who underwent surgery for an adamantinous craniopharyngeoma (WHO grade I). The postoperative course, during which the patient received 16 mg/day of dexamethasone, was initially uneventful. After a fortnight the patient developed infectious signs and an intracranial abscess at the operation site with simultaneous purulent coxitis. Both the intracranial abscess and the coxitis were evacuated and drained. In tissue samples and pus obtained during re-craniotomy and during surgery on the hip, Salmonella enteritidis was detected by cultivation. Salmonella enteritidis was also isolated from several stool specimens. There was no known salmonellosis in the patient's medical history. She recovered as a result of antibiotic treatment with ciprofloxacin and chloramphenicol. The intracranial abscess healed without leaving any neurological deficit. Unfortunately the left hip subsequently required further surgery, culminating in removal of the entire femoral head. Prosthetic replacement could not yet be performed due to the recurrent septic course of the hip. Our case illustrates a serious complication with presumed haematogenous spread of the infection from a pre-existing asymptomatic and unknown colon infection. The immunosuppressive effect of corticosteroids in the treatment of the brain neoplasm might have been a contributing factor to the sudden exacerbation of the latent infection.

Rare case of intracranial Salmonella enteritidis abscess following glioblastoma resection: Case report and review of the literature

“…[137212628–30] Table 1 lists the details of the reported cases, treatments and outcomes. Intracranial Salmonella infections were most frequently associated with glioblastoma (6 cases), craniopharyngioma (2 cases), and ependymoma, (1 case).…”

“…[1924] The predisposing factors for intracranial Salmonella include primary or metastatic brain tumors, areas of old ischemia or infarction, subarachnoid hemorrhage, epidural or subdural hematoma, and immunodeficiency. [137141921242628–30] Clinical presentations of brain abscess due to Salmonella have been divided into three groups: 1) brain abscess formation during Salmonella infection elsewhere in the body;[1] 2) abscess formation after recovery from Salmonella infection;[10] 3) abscess formation in patients without any previous history of Salmonella. [26] Our case belongs to this third group, where Salmonella infection was not even suspected.…”

<i>Salmonella</i> Infection after Surgery of Small Intestine Foreign Bodies

“…Postoperative infection with Salmonella is rarely encountered, and typically only reported in prosthetic replacement surgery and intracranial surgery [4][5][6] . Salmonellosis complicating a surgery for the removal of foreign bodies is very unusual.…”

“…Among more than 2,000 nontyphoidal serotypes, Salmonella enterica serotype choleraesuis shows a much higher predilection for causing bacteremia and invasive extraintestinal infections in humans [1][2][3] . Postoperative infection with Salmonella has been reported in rare cases of orthopedic prostheses replacement surgery and intracranial surgery [4][5][6] . However, such an infection has never been reported resulting from intestinal surgery.…”

Treatment of proximal femur infections with antibiotic-loaded cement spacers

“…Thus, in these cases a two-stage treatment is often required. Beyond the obligate systemic antibiosis, the common procedure includes an excision arthroplasty of the femoral head (Girdlestone-hip) with a simultaneous insertion of commercial antibiotic-loaded device (beads or collagen sponges) 16-18, 20. In case of multimicrobial infections, these commercial antibiotic-impregnated media cannot provide frequently a sufficient antibiotic therapy.…”