Salmonella osteomyelitis: A rare extraintestinal manifestation of an endemic pathogen

Abstract

Salmonella enterica serovar Typhi and Paratyphi usually cause enteric fever in humans characterized by fever and gastrointestinal symptoms such as diarrhea. Bacteremia is a constant feature of enteric fever, and occasionally, dissemination of bacilli throughout the body results in the establishment of one or more localized foci of persisting infection. This happens especially in patients with preexisting conditions such as hemoglobinopathies, previous joint trauma, surgery, connective tissue diseases, lymphoma, diabetes, alcoholism, immunosuppressive state, and extremes of ages. Rarely, these extraintestinal Salmonella infection cases have also been reported in immunocompetent individuals without any obvious predisposing factors. Salmonella osteomyelitis, a rare sequelae of typhoid, may occur as a result of hematogenous seeding of the bone or joints due to a bacteremic episode. It may also spread from nearby areas of infection or penetrating trauma. Timely diagnosis and treatment of this condition are necessary because if left untreated, it can lead to permanent functional deficits later on. We hereby present a case series with brief review of literature on Salmonella osteomyelitis in immunocompetent patients without any known predisposing conditions over a period of 1 year (2017–2018) from a Tertiary Care Teaching Hospital in Uttarakhand, India.

Salmonella Spondylodiscitis in a Patient with Sickle Cell Disease - Case Report and Literature Review

“…Isolating the organism from the blood or the infection site; either as image guided or monella is a rare cause of osteomyelitis with only 0.8% of all Salmonella infections seen in the musculoskeletal system [10]. Although Salmonella typhi is the main cause of Salmonella osteomyelitis, cases of paratyphi and nontyphi forms had also been reported [9,[11][12][13].…”

“…The diagnosis Salmonella spondylodiscitis is typically confirmed by images and isolating the organism from the blood or the site of infection [9]. Hence open or image-guided biopsy and cultures from affected intervertebral disc may be of great value in establishing the diagnosis of vertebral osteomyelitis, identifying the microorganism, and therefore guiding anti-microbial treatment.…”

“…Salmonella spondylodiscitis in usually seen in immunocompromised patients like SCD, leukemia, diabetes and patient on long term steroid. However, spondylodiscitis caused by Salmonella has also been reported in immunocompetent patients without any predisposing factors [9,25,26]. Therefore, Salmonella osteomyelitis should be suspected in immune competent patient with recent gastrointestinal infection [9].…”

“…Salmonella is gram negative bacilli of Enterobacteriaceae family [8]. There are two main species of Salmonella; Salmonella enteric and Salmonella bongori [9]. Sal- monella infection compared with general population [19].…”

A Case Report of Salmonella Typhi Osteomyelitis With Pathological Fracture in an Immunocompetent Adult

“…Regardless of the primary illness, Salmonella species as a causative agent of osteomyelitis is mostly seen in individuals with hemoglobinopathies and immunosuppressive disorders. It is very rarely seen in immunocompetent adults [2][3][4][5]. The clinical and radiological presentation is also indistinguishable from osteomyelitis caused by other common microorganisms.…”