Serum iron, prealbumin, D-dimer and prothrombin time are indicators of the diagnosis, severity and outcome of Salmonella enterica serovar Enteritidis infection

Abstract

Aims Salmonella enterica serovar Enteritidis (S. Enteritidis) infection is one of the main causes of foodborne illness among individuals in the military. In this study, we aimed to investigate indicators associated with the diagnosis, severity and outcome of S. Enteritidis infection, and to analyze the antimicrobial susceptibility of the isolated S. Enteritidis strains.Methods Routine stool test, fecal occult blood tests (FOBTs), routine blood tests and blood biochemical analyses were completed in our clinical laboratory. The stool samples were inoculated on Salmonella Shigella (SS) agar plates, the single bacterial colony was identified with mass spectrometry (MS). The serum agglutination test was performed to identify the Salmonella serotype. Antimicrobial susceptibility testing was performed using the minimal inhibitory concentration (MIC) method with the VITEK 2 COMPACT analyzer.Results Recently, 6 patients from one company visited our department complaining of fever, watery stool, abdominal pain and so on. The patients’ white blood cell (WBC) counts (66.7%), neutrophil percentages (100%), C-reactive protein (CRP) levels (100%), prothrombin times (PTs, 100%) and serum D-dimer concentrations (83.3%) were higher or longer than normal, while serum iron (100%) and prealbumin (83.3%) were lower than normal when they were admitted. Stool cultures and serovar identification results indicated S. Enteritidis infection. The antimicrobial susceptibility results showed that the 6 isolated bacterial strains were sensitive to trimethoprim-sulfamethoxazole and levofloxacin, and resistant to ampicillin. All patients were administered levofloxacin accompanied by rifaximin and probiotics, and their symptoms and the abovementioned parameters were recovered. During the disease course, the prolonged PT, elevated D-dimer and decreased serum iron were positively correlated with severe symptoms and serum inflammatory indexes.Conclusion Prolonged PT, elevated D-dimer and hypoferremia were associated with the diagnosis, severity and outcome of S. Enteritidis infection, and a decreased prealbumin level was associated with the diagnosis of S. Enteritidis infection. In patients complaining of acute fever, watery stool and abdominal pain, PT, D-dimer，prealbumin and serum iron should be monitored to attain an early diagnosis and initiate appropriate treatment for S. Enteritidis infection.