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Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 417-418
Infant bacteremia due to Salmonella typhimurium

1 Department of Microbiology, Government Medical College Hospital, Chandigarh - 160030, India
2 Department of Paediatrics, Government Medical College Hospital, Chandigarh - 160030, India

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Date of Web Publication27-May-2011

How to cite this article:
Rani H, Singla N, Chander J, Jain S. Infant bacteremia due to Salmonella typhimurium. Indian J Pathol Microbiol 2011;54:417-8

How to cite this URL:
Rani H, Singla N, Chander J, Jain S. Infant bacteremia due to Salmonella typhimurium. Indian J Pathol Microbiol [serial online] 2011 [cited 2020 Sep 25];54:417-8. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/417/81604


Like typhoidal  Salmonella More Detailse, non-typhoidal salmonellae (NTS) are also important pathogens causing human disease. Majority of NTS infections present as self-limiting gastroenteritis. However, neonates, infants of age <3 months, elderly and immunocompromised patients are especially vulnerable to invasive infections by NTS. [1] The neonates and children acquire infection by the ingestion of top feeds contaminated with infected water, from asymptomatic carriers or by direct exposure to excreta of reptiles, pet treats and other animals. [2] The infection is transmitted among household contacts or may also be hospital-acquired. [3] Amongst NTS, Salmonella typhimurium is the most frequently encountered serotype. [4] Hereby, we report a case of fatal bacteremia due to S. typhimurium in an infant.

A 3-month-old male child, weighing 5 kg, was admitted in the pediatric emergency with history of high grade fever and cough for 4 days, and loose, watery stools (8-10 episodes) and vomiting (3 episodes) since 1 day. On examination, the child was febrile with heart rate 132/minute, respiratory rate 69/minute and no cyanosis. On auscultation, bilateral equal air entry was present with occasional conducted sound. S1 and S2 were normal with doubtful soft systolic murmur Grade III. He was diagnosed as a case of acute bronchiolitis with acute gastroenteritis and congenital heart disease.

On investigations, his hemoglobin level was 10.8 g/dl, and sodium, potassium, urea and creatinine levels were within normal limits. The child was started on cefotaxime 80 mg once a day and amikacin 200 mg twice a day intravenously. However, by the end of second day, he developed respiratory distress, was intubated and put on ventilator. The antibiotics were changed to combination drug piperacillin + tazobactam 90 mg/kg and vancomycin 10 mg/kg thrice a day intravenously. But there was decreased air entry on the right side, thereby reducing oxygen saturation. Intercostal drain was put up, but his condition deteriorated. As shock worsened, cardiopulmonary resuscitation was done but the child did not survive. Blood culture done, during the stay of the child, grew S. typhimurium after 48 hours of incubation. The strain was identified as per the standard microbiological procedures. It is noteworthy that the child had two episodes of similar complaints 1 month prior to the present hospitalization. The child had been delivered per vaginally at full term in our hospital and had birth weight of 2 kg. The antenatal and postnatal period of mother was uneventful. The child was on exclusive breast feeding for the first 2 months, followed by bottle feeding with cow's milk in the dilution of 2:1.

The literature shows that S. typhimurium is one of the most commonly reported NTS serotypes causing bacteremia in neonates and children. The incidence has been reported to be 5% in western countries to up to 81% during nursery outbreaks in India. [5] In the present case, the factors contributing to bacteremia could be host associated (the child in early infancy) and environmental (child being bottle-fed with cow's milk which might be a source of infection). Antibiotic treatment is very important in cases with invasive disease or complicated bacteremia. However, S. typhimurium strains are increasingly being reported to be resistant due to frequent use of antimicrobials for disease prevention and growth promotion in food of animals along with poor sanitation facilities encouraging the spread of organisms. [2] This particular strain was sensitive to ciprofloxacin, chloramphenicol and cotrimoxazole, but resistant to ampicillin and only intermediate sensitive to cefotaxime. On further testing, as per Clinical Laboratory Standard Institute (CLSI) guidelines, the strain was found to be an extended spectrum β lactamase (ESBL) producer. [6]

We conclude that NTS bacteremia is an emerging disease entity and the strains like S. typhimurium which have the potential to harbour virulence plasmids, are serious threats. Timely detection of bacteremia by such organisms can have a profound influence on the final outcome of the patient. It is emphasized that a high index of suspicion should be kept to diagnose and treat the patients successfully at the earliest.

   References Top

1.Yen YF, Wang FD, Chiou CS, Chen YY, Lin ML, Chen TL, et al. Prognostic factors and clinical features of non-typhoid Salmonella bacteraemia in adults. J Chin Med Assoc 2009;72:408-13.  Back to cited text no. 1
2.Wright JG, Tengelsen LA, Smith KE, Bender JB, Frank RK, Grendon JH, et al. Multidrug-resistant Salmonella typhimurium in four animal facilities. Emerg Infect Dis 2005;11:1235-41.  Back to cited text no. 2
3.Morpeth SC, Ramadhani HO, Crump JA. Invasive non-Typhi Salmonella disease in Africa. Clin Infect Dis 2009;49:606-11.  Back to cited text no. 3
4.Kariuki S, Revathi G, Kariuki N, Kiiru J, Mwituria J, Muyodi J, et al. Invasive multidrug-resistant non-typhoidal Salmonella infections in Africa: Zoonotic or anthroponotic transmission?. J Med Microbiol 2006;55:585-91.   Back to cited text no. 4
5.Buch NA, Dhananjiya A. A nursery outbreak of multidrug resistant Salmonella typhimurium. Indian Pediatr 1998;35:455-9.   Back to cited text no. 5
6.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 18 th Informational Supplement. M100-S18. Wayne, Pa: Clinical and Laboratory Standards Institute;  2008.  Back to cited text no. 6

Correspondence Address:
Nidhi Singla
H. No. 1205, Sector 32 B, Chandigarh - 160 030
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.81604

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