Salmonella typhimurium Meningitis in an Infant Presenting with Recurrent Meningitis

Abstract

Salmonella typhimurium meningitis in infancy is very uncommon and does not respond to usual duration of empirical antibiotic therapy. A 5-mo-old infant presented with clinical picture of acute pyogenic meningitis and was treated with empirical antibiotic therapy for 14 d. But, 2 wk after the discharge, the child presented again with similar complaints. CSF culture had grown Salmonella typhimurium following which dual antibiotic therapy was given for 6 wk.

Successfully Treated Case of Non-Typhoidal Salmonella Meningitis in an Otherwise Healthy 5 Months Old Infant: A Case Report

“…However a study involving five Asian countries demonstrated Salmonella typhi and para-typhi to be the most common organism being isolated [12]. Salmonella species both typhi and non-typhi usually spread by faecooral contamination [1]. Therefore the presence of invasive Salmonella non-typhi disease in a region where S. typhi strains are endemic was a cause for concern as this patient also had no other risk factors and was also on exclusive breast feeding.…”

“…Acute bacterial meningitis, a medical emergency requires prompt treatment and early initiation of intravenous antibiotic therapy is required even before the etiology is known [1,2]. Only few case reports have been reported in literature of Salmonella typhimurium causing meningitis in immuno-competent infants especially from tropical countries [1,2,6]. A recent case report from India reported a case of acute pyogenic meningitis from Salmonella typhimurium leading to subdural empyema and brain abscess [6].…”

“…Acute bacterial meningitis in infants is a medical emergency requiring prompt diagnosis and early institution of empirical antibiotic therapy [1]. Salmonella, a gram negative motile bacilli, has been recognized to cause infectious diarrhoea, enteric fever, focal septic infections, bacteraemia and rarely osteomyelitis and meningitis [2].…”

“…They have been broadly classified in two types, Salmonella Typhi (which includes typhi and paratyphi species) and Salmonella Non-Typhi (with 80% of infections being caused by Salmonella typhimurium and Salmonella enteritidis) [3]. Nontyphoidal salmonella (NTS) is a major cause of uncomplicated infectious diarrhea worldwide; however NTS meningitis is extremely uncommon beyond the neonatal period with very few cases being reported in the literature [1,3]. Complicated NTS infections and bacteraemia typically occurs in infants having phagocytic or T-cell dysfunction such as HIV, causing immune-suppression and other conditions such as sickle cell disease causing salmonella osteomyelitis due to vasoocclusive crisis [1,3].…”

“…NTS being a facultative intracellular organism does not respond to conventional antibiotic therapy and therefore failure and relapse rates are higher particularly with meningitis. Hence prolonged treatment of 4-6 weeks has been recommended in recent case series with antibiotics that has good intracellular penetration such as third generation cephalosporins, fluoroquinolones and macrolides [1,3,8,9].…”