Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2010  |  Volume : 53  |  Issue : 3  |  Page : 572--573

Scalp abscess due to Salmonella typhimurium


Shrikala Baliga1, Shalini Shenoy1, Dominic R. M. Saldanha1, HV Prashanth2,  
1 Department of Microbiology, K.M.C., Mangalore, India
2 Department of Microbiology, Sri Siddhartha Medical College, Tumkur, India

Correspondence Address:
Shrikala Baliga
«SQ»Kshitij«SQ» Blueberry Hills, Yeyyadi, Mangalore-575 008
India




How to cite this article:
Baliga S, Shenoy S, Saldanha DR, Prashanth H V. Scalp abscess due to Salmonella typhimurium.Indian J Pathol Microbiol 2010;53:572-573


How to cite this URL:
Baliga S, Shenoy S, Saldanha DR, Prashanth H V. Scalp abscess due to Salmonella typhimurium. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Dec 2 ];53:572-573
Available from: https://www.ijpmonline.org/text.asp?2010/53/3/572/68247


Full Text

Sir,

The incidence of non-typhoidal salmonellosis has markedly increased in the past decade. [1] Gastroenteritis, bacteremia with or without focal lesions, enteric fever and asymptomatic carrier states are the common manifestations. [2] Localized infections develop in 5-10% of cases with salmonella bacteremia and the signs and symptoms are often delayed. [1]

A four-year old female child, a known case of acute lymphoid leukemia (ALL), presented with high grade intermittent fever with out chills and rigors and generalized body aches of six days duration. There was no history suggestive of respiratory or urinary tract infection. The patient had a temperature of 103.4 o F, pallor and ichthyosis. Pulse rate was 130/minute and the respiratory rate was 30/minute. Examination of the throat showed mild congestion with presence of oral thrush. Pustular lesions were observed over the right side of the scalp. Hepato-splenomegaly was present. The cardio-vascular system, respiratory system and central nervous system were normal. The scalp abscess was drained and pus was sent for culture and sensitivity. Blood was also sent for culture and sensitivity. Gram stain of pus from scalp abscess revealed numerous polymorphs and gram negative bacilli. The culture media used for isolation were blood agar and MacConkey's agar which were incubated at 37 o C for 24 hours after inoculation of clinical specimen. After incubation, the growth was observed to be heavy and the colonial growth was confirmed as Salmonella typhimurium based on standard microbiological procedures (biochemical and serological identification). The patient was started on cefotaxime. Other laboratory investigations showed Hb-5.4gm/100ml, total count -1300/ cu.mm; peripheral smear showed blasts -15%, promyelocytes-2%, myelocytes-2%, lymphocytes-58%, monocytes-1% and neutrophils-22%. After isolation, antibiotic sensitivity was done on Mueller Hinton agar plate using Kirby- Bauer disc diffusion method. The organism was found to be sensitive to chloramphenicol, ciprofloxacin, amikacin, cotrimoxazole, ceftriaxone, gentamicin, cefotaxime and resistant to ampicillin. Blood culture also grew the same organism.

Localized infection develops in approximately 5-10% of persons with salmonella bacteremia. [1] The species involved include Salmonella typhi, Salmonella cholerasuis and Salmonella typhimurium. Common extra-intestinal manifestations are osteomyelitis, endocarditis, septic arthritis, pyelonephritis, soft tissue infections like pustular dermatitis. [3] Wound infections and subcutaneous abscess are seen in < 1% of patients. Predisposing factors include local trauma and immunosuppression. [1] Our patient suffered from acute lymphoid leukemia (ALL) and had transient bacteremia. Bacteremia is seen in patients with underlying illness like carcinoma, lymphoma, and liver disease. [3] This greatly increases the risk of development of bacteremia.

The ability of S. typhimurium to cause metastatic lesions is due to gene phoP-phoQ. [4] Though the mortality rate from bacteremia in case of focal infections is 15%, our patient had an uneventful recovery after treatment with cefotaxime 500mg tds.

References

1Miller SI, Pegues DA. Salmonella species including Salmonella typhi. In: Mandell GL, Douglas RG, Bennett JE, editors. Principles and Practice of Infectious Diseases. 5 th ed. Vol. 2. Philadelphia: Churchill Livingstone Co.; 2000, p. 2346-52.
2Black PH, Kunz LJ, Swartz. Salmonellosis- A review of some unusual aspects. N Engl J Med 1960;262:811-7.
3Cherubin CE, Neu HC, Imperato PJ, Harvey RP, Bellen N. Septicemia with non-typhoid salmonella. Medicine 1974;53:365-76.
4Miller SI. phoP/ phoQ: Macrophage specific modulators of Salmonella virulence. Mol Microbiol 1991;5:2073-8.