Salmonella Meningitis in Chinese Children: A Series of Three Cases Over A 13-Year Period

Background: Salmonella is a common pathogen for gastroenteritis, but it rarely causes intracranial infection in China. To improve the understanding of pediatric Salmonella meningitis, we report three cases of Salmonella meningitis in Chinese children.Case presentation: The patients were aged from 1 day to 14 months. Fever was the first symptom in two patients, while loose stool with a little mucus occurred in one patient during the course of disease. Peripheral white blood cell count, neutrophils count, and C-reactive protein were 20.08 - 25.2 *109/L, 15.4 - 19.7 *109/L, and 1.6 - >160 mg/L, respectively. CSF analysis showed that white blood cell count, glucose, and protein were 70 - 1473 *106/L, 0.18 - 3.19 mmol/L, and 598.1 - 6639.0 mg/L, respectively. Three isolates of Salmonella were detected in cerebrospinal fluid cultures, including Salmonella newport, Salmonella paratyphi, and Salmonella typhimurium (one case per each). All strains were sensitive to ceftriaxone, ceftazidime, cefoperazone / sulbactam, meropenem, and imipenem, while one strain was resistant to ampicillin. The blood cultures were all negative. All patients were treated with carbapenems after failed therapies of cefotaxime or ceftriaxone, for a total duration of 3 - 5 weeks. One patient died, and subdural effusion occurred in one of the two survivors. Conclusions: Salmonella meningitis was rare, but the clinical conditions were serious. Carbapenems might be the first choice for treating Salmonella meningitis.

Salmonella Meningitis in a Two Months Infant from Odisha, India: A Rare Case Report

Salmonella meningitis is a disease with high mortality in infants though incidence is rare. This article reports a case of Salmonella meningitis in a two months male infant, who presented with high fever, convulsion and difficulty in breathing. Salmonella typhi was isolated from cerebrospinal fluid (CSF), that showed resistance to Cephalosporins, Fluroquinoles, Macrolides and Aminoglycosides but susceptiblity to Chloramphenicol and Cotrimaxozole. This case was admitted on fourth day of onset of illness and treated with parenteral Vancomycin and Ceftriaxone to cover both gram positive and negative bacterial agents of bacterial meningitis in a young infant, but succumbed to death on ninth day of illness. This indicated importance of S. typhi as a possible bacterial etiology and a great concern on resistance to the normally chosen antibiotics. An early suspicion can be suggested to reduce the risk of mortality. Environmental hygiene and household cleanliness practices also warrants attention, which were identified as possible risks for enteric infection in spite the baby was absolutely breast fed.

A case report of Salmonella meningitis in three Chinese children and a literature review

Background: Salmonella is a common pathogen for gastroenteritis, but it rarely causes intracranial infection in China. To improve the understanding of pediatric Salmonella meningitis, we report three cases of Salmonella meningitis in Chinese children.Case presentation: The patients were aged from 1 day to 14 months. Fever was the first symptom in two patients, while loose stool with a little mucus occurred in one patient during the course of disease. Peripheral white blood cell count, neutrophils count, and C-reactive protein were 20.08 - 25.2 *109/L, 15.4 - 19.7 *109/L, and 1.6 - >160 mg/L, respectively. CSF analysis showed that white blood cell count, glucose, and protein were 70 - 1473 *106/L, 0.18 - 3.19 mmol/L, and 598.1 - 6639.0 mg/L, respectively. Three isolates of Salmonella were detected in cerebrospinal fluid cultures, including Salmonella newport, Salmonella paratyphi, and Salmonella typhimurium (one case per each). All strains were sensitive to ceftriaxone, ceftazidime, cefoperazone / sulbactam, meropenem, and imipenem, while one strain was resistant to ampicillin. The blood cultures were all negative. All patients were treated with carbapenems after failed therapies of cefotaxime or ceftriaxone, for a total duration of 3 - 5 weeks. One patient died, and subdural effusion occurred in one of the two survivors. Conclusions: Salmonella meningitis was rare, but the clinical conditions were serious. Carbapenems might be the first choice for treating Salmonella meningitis.

Clinical Characteristics, Acute Complications, and Neurologic Outcomes of Salmonella Meningitis in Saudi Infants and Children

Objective This study aimed to clarify the clinical presentations, acute complications, and long-term sequelae of Salmonella meningitis in Saudi infants and children. Methods This retrospective study, conducted from 1999 to 2016, evaluated the neurological complications and long-term outcomes of children 14 years of age and younger diagnosed with Salmonella meningitis at King Khalid University Hospital. All affected children had 3 years of follow-up to assess neurologic complications and mortality. Results Invasive Salmonella infection occurred in 141 patients. Of those, 14 (10%) had meningitis. The median age of onset of infection was 4.7 months. The most frequent symptoms at presentation included fever (100%), seizures (71%), diarrhea, and vomiting (43%). Nontyphoidal Salmonella species were isolated in all (but one) cerebrospinal fluid samples. Relapse occurred in four patients owing to inadequate antibiotic duration, although the organisms were susceptible to ceftriaxone. The majority of patients (86%) developed acute neurologic complications, including subdural empyema and multiple cerebral infarcts (57%), hydrocephalus (36%), ventriculitis (29%), and cerebral venous sinus thrombosis (21%). Four patients (28.5%) died due to Salmonella meningitis complications. Four patients survived with full recovery. Six patients (60%) had long-term neurologic complications. Hydrocephalus, cerebral palsy, developmental delay, and epilepsy occurred in five, four, three, and three patients, respectively. Conclusion Salmonella meningitis results in significant mortality and adverse neurodevelopmental outcomes. The probability of relapse after an apparent recovery should be considered. Consensus on antibiotic treatment for Salmonella meningitis is needed.

Successfully Treated Case of Non-Typhoidal Salmonella Meningitis in an Otherwise Healthy 5 Months Old Infant: A Case Report

Acute bacterial meningitis in infants is a medical emergency requiring prompt diagnosis and early institution of empirical antibiotic therapy. Non-typhoidal salmonella (NTS) is a major cause of uncomplicated infectious diarrhoea worldwide; however NTS meningitis is extremely uncommon beyond the neonatal period with very few cases being reported in the literature and has been associated with increased mortality and morbidity with mortality rates of up to 40-70% reported in recent studies. NTS being a facultative intracellular organism does not respond to conventional antibiotic therapy and therefore failure and relapse rates are higher particularly with meningitis. We report a rare case of a five month old infant with non-typhoidal salmonella meningitis who was successfully treated with prolonged duration of antibiotic therapy.