Lung abscess caused by Salmonella
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《美国医学杂志》
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India
Salmonellosis More Details is a self-limiting illness of brief duration, usually characterized by diarrhea and fever. Localized infections are an important form of Salmonella More Details infection and are frequently seen during salmonella bacteraemia, but may also occur with enteric fever or gastroenteritis. Salmonella causing lung abscess is rare and not reported in immunocompetent children. However this condition can be well managed with appropriate antibiotic therapy and hence the report.
A five-year-old developmentally normal girl, first born to non-consanguineous parents was brought with history of cough and respiratory distress associated with low grade intermittent fever for five months duration. There was history of diarrhea for a week at the onset of the illness. On examination she was febrile and dyspnoeic. She had grade II clubbing and a prominent bulge on the right side of her chest anteriorly. Auscultation revealed cavernous breath sounds and post tussive crepitations in the right mammary and infrascapular areas. Mild enlargement of the liver and spleen was also noted. Investigations revealed the following: Hemoglobin 9.5 gm%, total leucocyte count 9600/cu.mm, differential count N 78%, L20%, E2%. An X-ray of the chest showed a thick walled abscess in the right lower zone with a fluid level Figure1. An ultrasonography guided aspiration of the abscess showed thick yellow pus with plenty of polymorphs. Culture of the pus grew group B salmonella sensitive to amikacin, ceftriaxone, and ceftazidime. Her blood culture was sterile and ELISA test for HIV was negative. She was treated with intravenous ceftriaxone for 2 weeks followed by oral cefixime for 2 more weeks. After 10 days of initiation of antibiotics she became afebrile. After a month she was completely asymptomatic and a repeat chest X-Ray showed complete resolution of the abscess Figure2.
Salmonella species (non-typhoidal) are commonly associated with acute gastro-enteritis in children in the developing world and contribute to one of the common causes of morbidity and mortality.[1] Extraintestinal infections due to these organisms are less frequently encountered, but if they are, most of them occur in immunocompromised adults.[2],[3] Our child did not have any underlying immunodeficiency condition, as she was apparently healthy, with a normal total leucocyte count and seronegativity for HIV. Pulmonary hydatid cyst secondarily infected with S. typhi has been reported in a 12 year old Pakistani girl.[4] However Salmonella as a primary cause of lung abscess in immunocompetent children is not reported so far.
The history of diarrhea at the onset of illness suggests the entry of the offending pathogen (group B Salmonella) through the gastro intestinal tract. The subsequent bacteremia would have led to the seeding of the organisms in the lung. However her blood culture was sterile, probably due to prior treatment with antibiotics before admission. The Salmonella serogroup B (especially S. typhimurium) are known for their plasmid mediated drug resistance, having acquired it from other enteric bacteria.[1] Treatment needs to be instituted with appropriate antibiotic, to prevent recurrence and complication, keeping in mind the potential resistant strains circulating in the community.[5]
References
1. Gomez HF, Cleary TG. Salmonella. In Textbook of Pediatric Infectious Disease, 4th edn. Philadelphia. Eds. Eigin RD, Cherry JD. W.B. Saunders, 1998; 1331-1334.
2. Casado JL, Navas E, Frutos B, Moreno A, Martin P, Hermida JM and Guerrero A. Salmonella lung involvement in patients with HIV infection. Chest 1997; 112 : 1197-1201.
3. Satue JA, Aguado JM, Ramon Costa J, Robledo M, De Miguel E, Hernandez J, Rioperez E. Pulmonary abscess due to non-typhi Salmonella in a patient with AIDS. Clin Infect Dis 1994; 19 : 555-557.
4. Aslam F, Bhaila I, Nadeem N, Fadoo Z. Salmonella typhi-infected lung hydatid cyst. Pediatr Infect Dis J 2005; 24:270-272.
5. Kanungo R, Kumar A, Srinivasan S, Badrinath S. Pleural empyema due to Group B Salmonella in a child with diarrhea. Ind Pediatr 2001; 38 : 186-189.(Adhisivam B, Mahadevan S,)
Salmonellosis More Details is a self-limiting illness of brief duration, usually characterized by diarrhea and fever. Localized infections are an important form of Salmonella More Details infection and are frequently seen during salmonella bacteraemia, but may also occur with enteric fever or gastroenteritis. Salmonella causing lung abscess is rare and not reported in immunocompetent children. However this condition can be well managed with appropriate antibiotic therapy and hence the report.
A five-year-old developmentally normal girl, first born to non-consanguineous parents was brought with history of cough and respiratory distress associated with low grade intermittent fever for five months duration. There was history of diarrhea for a week at the onset of the illness. On examination she was febrile and dyspnoeic. She had grade II clubbing and a prominent bulge on the right side of her chest anteriorly. Auscultation revealed cavernous breath sounds and post tussive crepitations in the right mammary and infrascapular areas. Mild enlargement of the liver and spleen was also noted. Investigations revealed the following: Hemoglobin 9.5 gm%, total leucocyte count 9600/cu.mm, differential count N 78%, L20%, E2%. An X-ray of the chest showed a thick walled abscess in the right lower zone with a fluid level Figure1. An ultrasonography guided aspiration of the abscess showed thick yellow pus with plenty of polymorphs. Culture of the pus grew group B salmonella sensitive to amikacin, ceftriaxone, and ceftazidime. Her blood culture was sterile and ELISA test for HIV was negative. She was treated with intravenous ceftriaxone for 2 weeks followed by oral cefixime for 2 more weeks. After 10 days of initiation of antibiotics she became afebrile. After a month she was completely asymptomatic and a repeat chest X-Ray showed complete resolution of the abscess Figure2.
Salmonella species (non-typhoidal) are commonly associated with acute gastro-enteritis in children in the developing world and contribute to one of the common causes of morbidity and mortality.[1] Extraintestinal infections due to these organisms are less frequently encountered, but if they are, most of them occur in immunocompromised adults.[2],[3] Our child did not have any underlying immunodeficiency condition, as she was apparently healthy, with a normal total leucocyte count and seronegativity for HIV. Pulmonary hydatid cyst secondarily infected with S. typhi has been reported in a 12 year old Pakistani girl.[4] However Salmonella as a primary cause of lung abscess in immunocompetent children is not reported so far.
The history of diarrhea at the onset of illness suggests the entry of the offending pathogen (group B Salmonella) through the gastro intestinal tract. The subsequent bacteremia would have led to the seeding of the organisms in the lung. However her blood culture was sterile, probably due to prior treatment with antibiotics before admission. The Salmonella serogroup B (especially S. typhimurium) are known for their plasmid mediated drug resistance, having acquired it from other enteric bacteria.[1] Treatment needs to be instituted with appropriate antibiotic, to prevent recurrence and complication, keeping in mind the potential resistant strains circulating in the community.[5]
References
1. Gomez HF, Cleary TG. Salmonella. In Textbook of Pediatric Infectious Disease, 4th edn. Philadelphia. Eds. Eigin RD, Cherry JD. W.B. Saunders, 1998; 1331-1334.
2. Casado JL, Navas E, Frutos B, Moreno A, Martin P, Hermida JM and Guerrero A. Salmonella lung involvement in patients with HIV infection. Chest 1997; 112 : 1197-1201.
3. Satue JA, Aguado JM, Ramon Costa J, Robledo M, De Miguel E, Hernandez J, Rioperez E. Pulmonary abscess due to non-typhi Salmonella in a patient with AIDS. Clin Infect Dis 1994; 19 : 555-557.
4. Aslam F, Bhaila I, Nadeem N, Fadoo Z. Salmonella typhi-infected lung hydatid cyst. Pediatr Infect Dis J 2005; 24:270-272.
5. Kanungo R, Kumar A, Srinivasan S, Badrinath S. Pleural empyema due to Group B Salmonella in a child with diarrhea. Ind Pediatr 2001; 38 : 186-189.(Adhisivam B, Mahadevan S,)