Salmonella typhi Meningitis in an Immunocompetent Asian Adult

Abstract

Enteric salmonella infections are common in the United States though nonenteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with meningitis signs and symptoms of >72 h duration like aseptic meningitis. A 25-year-old Indian male, without any past medical history brought by friends to the ER had fever and irritability for a week. He became increasingly somnolent and confused three days back. Physical exam reveals signs of meningitis and laboratory showed cerebrospinal fluid (CSF) studies suggestive of bacterial meningitis. Culture of CSF grew Salmonella typhi and later on blood culture also grew S. typhi. The patient became worse with cerebral edema and hydrocephalous suspected by change in neurological status and confirmed by ultrasound of eye ball examining optic nerve sheath diameter and CT scan of brain. The patient required neurosurgical intervention and hence external ventricular drain was placed. The patient was also placed on mechanical ventilation. Subsequently he developed ventilator associated pneumonia (VAP) with carbapenem-resistant Pseudomonas aeruginosa. The patient underwent tracheostomy and successfully completed treatment of VAP and was transferred to his home country after four months. Thus we describe a rare case of salmonella meningitis in an immunocompetent adult.

Salmonella Meningitis Complicated by Ventriculitis and Brain Abscesses in an HIV Positive Adult Patient

“…A defective cell-mediated immunity is postulated to pre-dispose HIV infected patients to invasive Salmonella infections. An intact regulatory cytokine cascade is important to defend against Salmonella, as demonstrated by the observation that patients with isolated interleukin-12 receptor defects are at increased risk of particularly severe Salmonella infections [ 1 ].…”

“…Salmonella infections can be enteric or non-enteric (abscesses, mycotic aneurysms, pneumonia, osteomyelitis, septic arthritis, endocarditis, and meningitis) or systemic (bacteremia) [ 1 ]. As with all opportunistic infections, HIV-positive patients are at increased risk of developing Salmonella bacteremia [ 2 ].…”

Salmonella Strain Specificity Determines Post-typhoid Central Nervous System Complications: Intervention by Lactiplantibacillus plantarum at Gut-Brain Axis

“…The situation, particularly in infants, presents with a poor prognosis along with relatively high mortality rate and is usually associated with serious side effects that can result in lasting damage (Dewan et al, 2009;Joshi et al, 2011). Incidence of not only typhoidal (Kankananarachchi et al, 2019) but also non-typhoidal serovars (Hanafi et al, 2020) is being increasingly implicated in such manifestations, which has alarmed the scientific community world over (Nadeem et al, 2019). Low index of suspicion, resulting in inability to provide prompt medication by the clinicians, has contributed to adverse outcome in patients (Samal et al, 2009).…”