Infantile meningitis due to Salmonella enteritidis
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《美国医学杂志》
Inonu University, School of Medicine, Department of Medical Microbiology, Malatya, Turkey
Sir,
Salmonella More Details species are well-known major causative pathogens of infantile bacterial meningitis in developing countries and are often associated with diarrhoea diseases and malnutrition.[1],[2] Patients are more likely to die from Salmonella meningitis than from meningitis due to the other major bacterial pathogens.[3] Salmonella enteritidis has been found to be second most common serotype in a review of Salmonella meningitis cases.[4] In the present letter a case of Infantile meningitis due to S. Enteritidis is reported.
A 3-month-old girl was referred to the department of pediatrics, Turgut Ozal Medical Center, Inonu University, with the complaints of pyrexia and convulsion. She had been treated in state hospital for 6 days with the diagnosis of bacterial meningitis. Despite the empirical treatment of vancomycin and ceftriaxone, she had had persistent fever and convulsion. Later, she was referred to this hospital. On admission she was weighing 6.3 Kg. Her axillary body temperature was 38.5 o C, and her respiratory rate was 42/minutes. Results of laboratory tests were white blood cell; 7200/mm, erythrocyte sedimentation rate; 95mm/h, C-reactive protein; 31mg/dl. Computerized brain tomography demonstrated subdural effusion. Glucose and protein levels of cerebrospinal fluid (CSF) were 1mg/dl and 206 mg/dl respectively. The blood and CSF samples were inoculated into Bactec Blood culture bottles and incubated in the Bactec 9120 System (Becton Dickinson, Sparks, Maryland, USA) and they were positive for gram negative bacteria, subsequently, identifiedas S. Enteritidis. The organism was identified as Salmonella by conventional biochemical tests. It was confirmed with the API 20E system (bio Merieux, Marcy-1' Etiole, France) and serotyped as S. Enteritidis by slide agglutination with specific Salmonella polyvalent and monovalent antisera (Denka Seiken Co. Ltd., Japan).
Antimicrobial testing using the standard Kirby-Bauer method, the isolate was sensitive to ciprofloxacin, chloramphenicol, cefotaxime, cefotaxime, ceftriaxone, and meropenem but resistant to ampicillin and co-trimoxazole. Parenteral meropenem therapy was started. Convulsions ceased, but the child died on the second day after the initiation of meropenem therapy. Although the above mentioned antibiotics were effective in vitro against Salmonella pathogen, the child death might have been due to delay in proper therapy initiation as there was a delay in transporting of the patient to the hospital. Delayed initiation of therapy or delayed referral to the hospital by the child's family may be the probable explanation for the child's death as there is poor health awareness status in the local community. Thus, further improvement in Salmonella meningitis necessitates an early initiation of appropriate effective antibiotic therapy.
Malnutrition and HIV infection and sickle cell disease are the conditions directing to suspicion of Salmonella meningitis.[3],[5] The patient had neither gastrointestinal system symptoms nor predisposing factors such as malnutrition, HIV & Sickle cell disease. Salmonella meningitis should be suspected in an otherwise healthy febrile infant with only seizures. Immediate suitable treatment is essential to obtain satisfactory recovery.
References
1.Ghadage DP, Bal AM. An unusual serotype of Salmonella from a case of meningitis in a neonate. Indian J Pediatr 2001; 68(11) : 1088.
2.Srifuengfung S, Chokephaibulkit K, Yungyuen T, Tribuddharat C. Salmonella meningitis and antimicrobial susceptibilities. Southeast Asian J Trop Med Public Health 2005; 36(2) : 312-316.
3.Owusu-Ofori OA, Scheld WM. Treatment of Salmonella meningitis: two case reports and a review of the literature. Int J Infect Dis 2003; 7(1): 53-60.
4.Molyneux E, Walsh A, Phiri A, Molyneux M. Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97. Trop Med Int Health 1998; 3(8): 610-618.
5.Brent AJ, Oundo JO, Mwangi I, Ochola L, Lowe B, Berkley JA. Salmonella bacteremia in Kenyan children. Pediatr Infect Dis J 2006; 25(3) : 230-236.(Bayraktar Mehmet Refik, Yetkin Gulay, Is)
Sir,
Salmonella More Details species are well-known major causative pathogens of infantile bacterial meningitis in developing countries and are often associated with diarrhoea diseases and malnutrition.[1],[2] Patients are more likely to die from Salmonella meningitis than from meningitis due to the other major bacterial pathogens.[3] Salmonella enteritidis has been found to be second most common serotype in a review of Salmonella meningitis cases.[4] In the present letter a case of Infantile meningitis due to S. Enteritidis is reported.
A 3-month-old girl was referred to the department of pediatrics, Turgut Ozal Medical Center, Inonu University, with the complaints of pyrexia and convulsion. She had been treated in state hospital for 6 days with the diagnosis of bacterial meningitis. Despite the empirical treatment of vancomycin and ceftriaxone, she had had persistent fever and convulsion. Later, she was referred to this hospital. On admission she was weighing 6.3 Kg. Her axillary body temperature was 38.5 o C, and her respiratory rate was 42/minutes. Results of laboratory tests were white blood cell; 7200/mm, erythrocyte sedimentation rate; 95mm/h, C-reactive protein; 31mg/dl. Computerized brain tomography demonstrated subdural effusion. Glucose and protein levels of cerebrospinal fluid (CSF) were 1mg/dl and 206 mg/dl respectively. The blood and CSF samples were inoculated into Bactec Blood culture bottles and incubated in the Bactec 9120 System (Becton Dickinson, Sparks, Maryland, USA) and they were positive for gram negative bacteria, subsequently, identifiedas S. Enteritidis. The organism was identified as Salmonella by conventional biochemical tests. It was confirmed with the API 20E system (bio Merieux, Marcy-1' Etiole, France) and serotyped as S. Enteritidis by slide agglutination with specific Salmonella polyvalent and monovalent antisera (Denka Seiken Co. Ltd., Japan).
Antimicrobial testing using the standard Kirby-Bauer method, the isolate was sensitive to ciprofloxacin, chloramphenicol, cefotaxime, cefotaxime, ceftriaxone, and meropenem but resistant to ampicillin and co-trimoxazole. Parenteral meropenem therapy was started. Convulsions ceased, but the child died on the second day after the initiation of meropenem therapy. Although the above mentioned antibiotics were effective in vitro against Salmonella pathogen, the child death might have been due to delay in proper therapy initiation as there was a delay in transporting of the patient to the hospital. Delayed initiation of therapy or delayed referral to the hospital by the child's family may be the probable explanation for the child's death as there is poor health awareness status in the local community. Thus, further improvement in Salmonella meningitis necessitates an early initiation of appropriate effective antibiotic therapy.
Malnutrition and HIV infection and sickle cell disease are the conditions directing to suspicion of Salmonella meningitis.[3],[5] The patient had neither gastrointestinal system symptoms nor predisposing factors such as malnutrition, HIV & Sickle cell disease. Salmonella meningitis should be suspected in an otherwise healthy febrile infant with only seizures. Immediate suitable treatment is essential to obtain satisfactory recovery.
References
1.Ghadage DP, Bal AM. An unusual serotype of Salmonella from a case of meningitis in a neonate. Indian J Pediatr 2001; 68(11) : 1088.
2.Srifuengfung S, Chokephaibulkit K, Yungyuen T, Tribuddharat C. Salmonella meningitis and antimicrobial susceptibilities. Southeast Asian J Trop Med Public Health 2005; 36(2) : 312-316.
3.Owusu-Ofori OA, Scheld WM. Treatment of Salmonella meningitis: two case reports and a review of the literature. Int J Infect Dis 2003; 7(1): 53-60.
4.Molyneux E, Walsh A, Phiri A, Molyneux M. Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97. Trop Med Int Health 1998; 3(8): 610-618.
5.Brent AJ, Oundo JO, Mwangi I, Ochola L, Lowe B, Berkley JA. Salmonella bacteremia in Kenyan children. Pediatr Infect Dis J 2006; 25(3) : 230-236.(Bayraktar Mehmet Refik, Yetkin Gulay, Is)