Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2012  |  Volume : 55  |  Issue : 4  |  Page : 608--609

Salmonella enterica serovar Typhi in breast abscess: A case report


E Sathish Kumar1, R Esther Mary Selvam2, S Srivani Ramesh1,  
1 Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, India
2 Department of Microbiology, ESIC Hospital, K.K.Nagar, Chennai, India

Correspondence Address:
S Srivani Ramesh
Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai
India




How to cite this article:
Kumar E S, Selvam R E, Ramesh S S. Salmonella enterica serovar Typhi in breast abscess: A case report.Indian J Pathol Microbiol 2012;55:608-609


How to cite this URL:
Kumar E S, Selvam R E, Ramesh S S. Salmonella enterica serovar Typhi in breast abscess: A case report. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Oct 20 ];55:608-609
Available from: https://www.ijpmonline.org/text.asp?2012/55/4/608/107857


Full Text

Sir,

Salmonella enterica serovar Typhi (S. typhi) causes typhoid fever which is an acute, invasive, generalized infection of the reticuloendothelial system and is endemic in many parts of India. Typhoid fever occurs more commonly in developing countries where sanitation is poor and where there is faecal contamination of food and water. [1] The morbidity of typhoid fever is more severe among infected patients with immune suppression, biliary and urinary tract abnormalities, reticuloendothelial blockade, and infection with multidrug resistant S. typhi strains. [2] Breast abscess due to S. typhi infection is a rare sequelae. Here, we report a case of breast abscess due to S. typhi.

A 60-year-old diabetic female presented with the history of mild fever for 3 days and painful swelling in the breast. There was no past history of chest pain or abdominal pain. On local examination, there was a single swelling of size 5 4 cm in the subareolar region on the right upper quadrant. There was no discharge from the nipple. The patient was nonalcoholic and nonsmoker and the blood pressure was 118/80 mmHg. No abnormalities were seen in respiratory system, cardiovascular system, central nervous system and abdomen. Pus sample was collected by fine-needle aspiration cytology (FNAC) from the swollen area and processed according to standard protocols for microbiological analysis. [3] Initially, the patient was started on oral amoxicillin-clavulanic acid 625 mg for 1 week. Lab investigations revealed that her hemoglobin level was 12.2 gm/dL, blood urea was 15.1 mg/dL, serum creatinine was 0.5 mg/dL, liver function test and total leucocyte count was in normal range. The patient was negative for HIV, HBsAg and malarial parasite. The pus culture yielded a pure growth of S. typhi. The organism was resistant to ciprofloxacin and sensitive to ampicillin-sulbactam, cefoperazone-sulbactam, cefepime, cefixime, ceftazidime, colistin, cotrimoxazole, amikacin, gentamicin, imipenem, meropenem, piperacillin-tazobactam, ticarcillin, ticarcillin-clavulanic acid and tobramycin. Blood culture showed no growth. Widal test showed titres of S. typhi 'H' 1:40 and 'O' 1:80. Titres for 'AH' and 'BH' were less than 1:20. When the patient came to collect her laboratory test results after 1 week, she was admitted and put on cefoperazone-sulbactam 500 mg and amikacin 1 g injection twice daily for a week, which gave favorable response. The patient was discharged after 1 week of treatment with an advice to take cefixime 200 mg twice daily for 7 days.

S. typhi is endemic in India which causes typhoid fever or gastroenteritis. They receive more attention because of the higher morbidity and mortality and their multidrug-resistant nature. The most important complications of typhoid fever are intestinal perforation, hemorrhage and circulatory collapse. Breast infection due to S. typhi is rare and unusual and no previous reports were available in Chennai. Very few reports of S. typhi isolation from bilateral breast abscess were available in India. [4],[5] Similarly, from France, a breast abscess case due to S. typhi was reported. [6]

In the present situation we have isolated S. typhi from a breast abscess which is a rare and unusual isolation of S. typhi from our clinical setup. Interestingly we have also observed ciprofloxacin resistance (MIC 8 μg/ml) in the S. typhi strain. However, it was uniformly sensitive to all the cephalosporins so we could successfully treat the patient with cefoperazone-sulbactam and amikacin injections.

References

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2Cohen JI, Bartlett JA, Corey GR. Extra-intestinal manifestations of Salmonella infections. Medicine (Baltimore) 1987;66:349-88.
3Winn W, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al. Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 6 th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 95,96, 251-258.
4Singh S, Pandya Y, Rathod J, Trivedi S. Bilateral breast abscess: A rare complication of enteric fever. Indian J Med Microbiol 2009;27:69-70.
5Singh G, Dasgupta M, Gautam V, Behera A, Ray P. Bilateral Breast Abscesses due to Salmonella Enterica Serotype Typhi. J Glob Infect Dis 2011;3:402-4.
6Delori M, Abgueguen P, Chennebault JM, Pichard E, Fanello S. Breast abscess with Salmonella typhi and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 2007;36:709-12.