Meningitis por Salmonella Enteritidis en un lactante: comunicación de un caso y revisión de la literatura / Salmonella Enteritidis meningitis in an infant: case report and literature review

Resumen La meningitis por Salmonella spp. es infrecuente en pediatría, pero debe sospecharse especialmente en menores de seis meses. Salmonella subespecie enterica es la más frecuente a nivel mundial, siendo el serovar Enteritidis el más importante. Tiene una alta tasa de complicaciones, predominando las colecciones y abscesos, por lo que se recomienda realizar una neuroimagen a todos los pacientes. A pesar que el manejo no está estandarizado, hay consenso en que el tratamiento de elección son las cefalosporinas de tercera generación. La resistencia antimicrobiana es infrecuente pero va en aumento, principalmente en países subdesarrollados. Presentamos el primer caso publicado en Chile de una meningitis por S. Enteritidis en un lactante de 11 meses, que se presentó con fiebre y una convulsión focalizada, con hemocultivos y cultivo de líquido cefalorraquídeo positivos. El paciente completó tratamiento con ceftriaxona y ciprofloxacina por cuatro semanas con buena respuesta.

Abstract Salmonella spp meningitis is rare in pediatrics. However, it should be especially suspected in children younger than 6 months. The enteric subspecies is the most frequent worldwide, with the Enteritidis serovar being the most important. The complication rate is high, with collections and abscesses predominating. For this reason, neuroimaging is currently recommended for all patients. Even though management is not standardized, there is consensus that first line treatment should be with third generation cephalosporins. Antibiotic resistance is infrequent but increasing, mainly in underdeveloped countries. We present the first case reported in Chile of meningitis by Salmonella Enteritidis in an 11-month-old infant presenting with fever and focused epileptic crisis. Blood culture and cerebrospinal fluid culture were positive. The patient completed four weeks of treatment with ceftriaxone and ciprofloxacin with a good response.

Latex proteins downregulate inflammation and restores blood-coagulation homeostasis in acute Salmonella infection

BACKGROUND Calotropis procera latex protein fraction (LP) was previously shown to protect animals from septic shock. Further investigations showed that LP modulate nitric oxide and cytokines levels. OBJECTIVES To evaluate whether the protective effects of LP, against lethal bacterial infection, is observed in its subfractions (LPPII and LPPIII). METHODS Subfractions (5 and 10 mg/kg) were tested by i.p. administration, 24 h before challenging with lethal injection (i.p.) of Salmonella Typhimurium. LPPIII (5 mg/kg) which showed higher survival rate was assayed to evaluate bacterial clearance, histopathology, leukocyte recruitment, plasma coagulation time, cytokines and NO levels. FINDINGS LPPIII protected 70% of animals of death. The animals given LPPIII exhibited reduced bacterial load in blood and peritoneal fluid after 24 h compared to the control. LPPIII promoted macrophage infiltration in spleen and liver. LPPIII restored the coagulation time of infected animals, increased IL-10 and reduced NO in blood. MAIN CONCLUSIONS LPPIII recruited macrophages to the target organs of bacterial infection. This addressed inflammatory stimulus seems to reduce bacterial colonisation in spleen and liver, down regulate bacterial spread and contribute to avoid septic shock.

Septic arthritis caused by Salmonella enterica serotype Rubislaw: A case report

Abstract An eleven-year-old boy presented with fever and hip pain, with limited mobility of the right side of the hip. Computed tomography scan revealed an increased volume of the right coxo-femoral joint, requiring surgical drainage of purulent secretion, from which Salmonella enterica was isolated. After four weeks of treatment with third-generation cephalosporin, he was discharged with a favorable evolution. Invasive disease caused by Salmonella spp represents a small proportion of salmonellosis cases, although it is responsible for greater rates of hospitalization, morbidity and mortality. Children under 5 years, elders over 60 years and immunodeficient patients have greater risk for invasive salmonellosis.

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient / Sepse grave por salmonelose Ciprofloxacino-resistente em paciente transplantado renal

Abstract Introduction: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. Case Report: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. Conclusion: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Resumo Introdução: A salmonelose é uma complicação relativamente rara em transplantados renais, e não pode ser diferenciada de outras formas de enterite pela apresentação clínica. Em pacientes transplantados renais, a salmonelose varia em gravidade, e é frequentemente associada com formas extra intestinais, bacteremia, e, neste caso, com elevada mortalidade. Relato de Caso: Descrevemos o caso clínico de um paciente transplantado renal com salmonelose Ciprofloxacino-resistente. Conclusão: Este caso ilustra o risco, relacionado à imunossupressão, da ocorrência de formas raras de infecção, por vezes de difícil diagnóstico, e com cursos clínicos potencialmente graves e prognóstico ruim, apesar do emprego de antibioticoterapia empírica adequada e de acordo com as evidências disponíveis.

In-Vitro Study of Antimicrobial Activities of Five Different Commercial Fixed Dose Combination Drugs in Indian Market.

Objective: In-vitro determination of antimicrobial activities of five different fixed dose combination drugs (FDC). Material and methods: Five antibiotic combination tablets [Cefadroxil plus Clavulanic acid (500:125 mg), Cefuroxime plus Clavulanic acid (500 : 125 mg), Cefixime plus Clavulanic acid (200 : 125 mg), Cefixime plus Ofloxacin (200 : 200 mg) and Cefixime plus Azithromycin (200 : 500 mg)] were tested for antimicrobial action against different microorganisms after their successful incubation for 18 hours at 37°C. Broth dilution or agar dilution methods were used to evaluate susceptibility of microorganisms. Results: 􀁺 Minimum inhibitory concentration (MIC) of Cefadroxil in combination with clavulanic acid reduced by 25%, 29%, 85% and 50%, against S. aureus, K. pneumonia, H. influenzae and S. pneumoniae respectively. 􀁺 No reduction was seen in MIC of Cefuroxime against S. aureus, K. pneumonia, H. influenzae, E. coli or S. pneumoniae after addition of Clavulanic acid. 􀁺 MIC of Cefixime against S. pneumoniae reduced from 0.2 to 0.14 when combined with Clavulanic acid. 􀁺 MIC of Ofloxacin against K. pneumoniae, E.coli and S. pneumoniae reduced by 82%, 50% and 85% respectively in combination with Cefixime. 􀁺 MIC of Cefixime against E.coli, S. typhi and S. pneumoniae reduced by 95%, 90% and 40% respectively in combination with Ofloxacin. 􀁺 MIC of Cefixime against S. typhi and S. pneumoniae reduced by 33.33% and 60% respectively with addition of Azithromycin. 􀁺 MIC of Azithromycin against S. typhi reduced by 70% after addition of Cefixime. Conclusion: Combination of Cefixime and Ofloxacin improves susceptibility of E. coli and S. pneumoniae. Addition of Azithromycin or Ofloxacin improves susceptibility of S. typhi against Cefixime. MIC of Azithromycin also improves with addition of Cefixime. Addition of Clavulanic acid improves antimicrobial action of Cefixime against S. pneumoniae and Cefadroxil against S. aureus, K. pneumonia, H influenza and S. pneumonia.

Anti-bacterial activity of Achatina CRP and its mechanism of action.

The physiological role of C-reactive protein (CRP), the classical acute-phase protein, is not well documented, despite many reports on biological effects of CRP in vitro and in model systems in vivo. It has been suggested that CRP protects mice against lethal toxicity of bacterial infections by implementing immunological responses. In Achatina fulica CRP is a constitutive multifunctional protein in haemolymph and considered responsible for their survival in the environment for millions of years. The efficacy of Achatina CRP (ACRP) was tested against both Salmonella typhimurium and Bacillus subtilis infections in mice where endogenous CRP level is negligible even after inflammatory stimulus. Further, growth curves of the bacteria revealed that ACRP (50 µg/mL) is bacteriostatic against gram negative salmonellae and bactericidal against gram positive bacilli. ACRP induced energy crises in bacterial cells, inhibited key carbohydrate metabolic enzymes such as phosphofructokinase in glycolysis, isocitrate dehydrogenase in TCA cycle, isocitrate lyase in glyoxylate cycle and fructose-1,6-bisphosphatase in gluconeogenesis. ACRP disturbed the homeostasis of cellular redox potential as well as reduced glutathione status, which is accompanied by an enhanced rate of lipid peroxidation. Annexin V-Cy3/CFDA dual staining clearly showed ACRP induced apoptosis-like death in bacterial cell population. Moreover, immunoblot analyses also indicated apoptosis-like death in ACRP treated bacterial cells, where activation of poly (ADP-ribose) polymerase-1 (PARP) and caspase-3 was noteworthy. It is concluded that metabolic impairment by ACRP in bacterial cells is primarily due to generation of reactive oxygen species and ACRP induced anti-bacterial effect is mediated by metabolic impairment leading to apoptosis-like death in bacterial cells.

Nontyphoidal Salmonella urinary tract infection in a case of hyperparathyroidism and nephrocalcinosis / Infección de las vías urinaria por Salmonella no tifoidea en un caso de hiperparatiroidismo y nefrocalcinosis

Nontyphoidal Salmonella infections often present with self-limited gastroenteritis. Extraintestinal focal infections are uncommon but have high mortality and morbidity. Urinary tract infection caused by nontyphoidal Salmonella is usually associated with structural abnormalities of the urinary tract. Nephrocalcinosis and nephrolithiasis are the major risk factors. Although primary hyperparathyroidism has been reported to increase the risk of nephrocalcinosis and nephrolithiasis, little is known about the association between hyperparathyroidism and Salmonella urinary tract infection. We report the case of a 37-year old man who had a history of primary hyperparathyroidism and bilateral nephrocalcinosis and who developed urinary tract infection. Salmonella Group D was isolated from his urine specimen. Salmonella should be considered as a possible causality organism in patients with primary hyperparathyroidism and nephrocalcinosis who develop urinary tract infection. These patients need to be aware of the potential risks associated with salmonellosis.

Las infecciones por Salmonella no tifoidea se presentan a menudo con gastroenteritis auto-limitada. Las infecciones extra-intestinales focales son poco frecuentes, pero tienen una alta mortalidad y morbilidad. La infección de las vías urinarias causada por la Salmonella no tifoidea se asocia generalmente a anomalías estructurales de las vías urinarias. La nefrocalcinosis y la nefrolitiasis son los principales factores de riesgo. Aunque se ha reportado que el hiperparatiroidismo primario aumenta el riesgo de la nefrocalcinosis y la nefrolitiasis, poco se sabe sobre la asociación entre el hiperparatiroidismo y la infección de las vías urinarias por Salmonella. Damos a conocer aquí el caso de un hombre de 37 años con una historia de hiperparatiroidismo primario y nefrocalcinosis bilateral, que desarrolló una infección de las vías urinarias. La Salmonella del grupo D fue aislada de su muestra de orina. La Salmonella se debe considerar como un posible organismo de causalidad en pacientes con hiperparatiroidismo primario y nefrocalcinosis que desarrollan infección del tracto urinario. Estos pacientes necesitan tomar conciencia de los riesgos potenciales asociados con la salmonellosis.

Salmonelosis neonatal: reporte de un caso y revisión de la literatura / Neonatal Salmonella infections: a case report and literature review

En Chile aún existe la salmonelosis como causal de enfermedad entérica, prevaleciendo el serotipo Enteritidis. En sepsis neonatal el germen más frecuente es Streptococcus grupo B (SGB); los bacilos Gram negativos entéricos ocupan el segundo lugar. La Salmonella spp. es infrecuente. Las vías de transmisión pueden ser hematógena, canal del parto, ascendente u horizontal. CASO CLÍNICO: Mujer sana, 31 años, embarazo de 39 semanas. Cultivo de SGB negativo. Presenta cuadro diarreico el día previo al parto, el cual fue vaginal, dilatación de cuatro horas, expulsivo de 15 minutos, líquido amniótico claro, destaca temperatura (T°) intraparto de 38,3°C. Recién nacido (RN)sexo masculino, adecuado para la edad gestacional, Apgar 9/9,con T° rectal 38,1°C al nacer. Al segundo día de vida presenta deposiciones líquidas verdosas con estrías de sangre, descenso de peso de 10,6 por ciento (367,82 gr) y T° rectal 37,7°C. Ingresa a neonatología, destacando Proteína C Reactiva elevada de 2,7 mg/dL. Por persistir cuadro se solicitan cultivos previo a antibioterapia con Ampicilina y Gentamicina. Test APT-Downey positivo, cultivo orina y líquido cerebroespinal negativos, hemocultivo y coprocultivo positivo a Salmonella tipo D subtipo Panamá. Evoluciona favorablemente, es dado de alta al noveno día con diagnóstico de sepsis por Salmonella tipo D connatal. Coprocultivo de madre positivo para Salmonella. DISCUSIÓN: La prevalencia de infecciones por Salmonella se ha incrementado en neonatos. Es importante realizar prevención durante el embarazo además de un diagnóstico y tratamiento precoz. Se debe considerar este agente según factores de riesgo y como diagnóstico diferencial de hemorragia digestiva baja en el RN...

Salmonella infections are still a cause of entericdisease in Chile, with a predominance of the Enteritidis serotype. In neonatal sepsis the most frequent etiology is Group B Streptococcal (GBS) infection; enteric Gram-negative bacilli occupy second place. Salmonella spp. is infrequent. The transmission routes can be hematogenous, by birth canal, vertical, or horizontal. CASE REPORT: Healthy 31 year old female, 39 week pregnancy. Negative GBS culture. Presents with diarrhea the day before labor, with vaginal delivery, four hour dilation period,15 minute expulsion period, clear amniotic fluid, intra delivery temperature (T°) of 38.3°C. Male, adequate for gestational age newborn, Apgar 9/9, with rectal T° of 38.1°C at birth. During second day of life, presents green liquid stools with blood streaks, weight loss of 10.6 percent (367.82 gr), and rectal T° of 37.7°C. Patient is admitted to neonatology service, where he presents elevated C-Reactive Protein of 2.7 mg/dL. Cultures were taken due to persistent findings, before antibiotic therapy with Ampicillinand Gentamicin. Positive APT-Downey test, negative urine and cerebrospinal fluid cultures, positive blood and stool cultures for type D, subtype Panama Salmonella. Favorable evolution, discharged on day nine with diagnosis of sepsis due to connatal type D Salmonella. Mother’s stool culture is positive for same bacteria. DISCUSSION: The prevalence of Salmonella infections has increased in neonates. Prevention during pregnancy, along with early diagnosis and treatment, are important. This agent should be considered according to risk factors, and as a differential diagnosis of lower gastrointestinal bleeding in newborns...

Recurrent meningitis due to Salmonella enteritidis: A case report from Kashmir India.

Recurrent bacterial meningitis in children is potentially life-threatening and induces psychological trauma to the patients through repeated hospitalization. Here we report a case of recurrent meningitis in a one month old baby. The CSF and blood culture grew Salmonella enteritidis. Injection ciprofloxacin and ceftriaxone were given for 3 weeks. Baby became symptomatically better and was afebrile at discharge. Twenty eight days after discharge baby got readmitted with complaints of fever and refusal of feeds. Blood and CSF culture again showed growth of Salmonella enteritidis. Physicians should be educated about the possibility of recurrence which may occur days or even weeks after apparent successful antibiotic treatment.

Prevalence of R-type ACSSuT in strains of Salmonella serovar Typhimurium DT193 isolated from human infections in Brazil / Prevalencia de resistencia de tipo ACSSuT en cepas de Salmonella serovariedad Typhimurium DT193 aisladas a partir de infecciones humanas en el Brasil

OBJECTIVE: To determine the prevalence of resistance to ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracyclines (ACSSuT) in Salmonella serovar Typhimurium definitive [phage] type (DT) 193 strains isolated from human sources over the last four decades. METHODS: From 2008 to 2010, 553 DT193 isolates out of 810 human-origin Salmonella ser. Typhimurium phage-typed strains isolated from the 1970s through 2008 were selected and tested for ACSSuT resistance: 91 strains isolated during the 1970s, 65 from the 1980s, 70 from the 1990s, and 327 from 2000-2008. Resistance profiles were determined using the disk diffusion method. RESULTS: †An antimicrobial susceptibility assay indicated 20.9 percent, or 116, of all isolates tested were ACSSuT-resistant, 52.0 percent (287) were resistant to one or more drugs in the ACSSuT profile, and 27.1 percent (150) were nonresistant (susceptible to antimicrobials). Based on the assay, overall antimicrobial resistance was extremely high in the 1970s (affecting 99.0 percent of isolates from that period) and remained high during the 1980s, when 95.4 percent of isolates had some type of antimicrobial resistance and incidence of Salmonella ser. Typhimurium DT193 R-type ACSSuT increased to 73.8 percent. R-type ACSSuT dropped to 27.1 percent (19 isolates) during the 1990s, and to 5.2 percent (17) during 2000-2008, despite a substantial increase in the number of isolates tested (397 versus 204, 111, and 98, respectively, for the previous three decades). CONCLUSIONS: †Although prevalence of Salmonella ser. Typhimurium DT193 R-type ACSSuT in Brazil has decreased since the 1970s, ACSSuT resistance markers continue to circulate. Therefore, continuous surveillance should be conducted to evaluate the occurrence of Salmonella ser. Typhimurium DT193 and its antimicrobial resistance.

OBJETIVO: Determinar la prevalencia de resistencia a la ampicilina, el cloranfenicol, la estreptomicina, las sulfonamidas y las tetraciclinas (ACSSuT) en cepas de Salmonella serovariedad Typhimurium fagotipo definitivo (DT) 193 aisladas de fuentes de origen humano durante las cuatro últimas décadas. MÉTODOS: Entre el 2008 y el 2010 se seleccionaron 553 aislados de DT193 entre 810 cepas de Salmonella serovariedad Typhimurium fagotipificadas aisladas desde la década de 1970 hasta el 2008, y en ellos se analizó la resistencia a ACSSuT: se estudiaron 91 cepas aisladas durante la década de 1970, 65 aisladas durante la década de 1980, 70 aisladas durante la década de 1990, y 327 aisladas entre el 2000 y el 2008, respectivamente. Los perfiles de resistencia a los antibióticos se determinaron mediante el método de difusión en disco. RESULTADOS: El antibiograma indicó que 20,9 por ciento (116) de todos los aislados que se analizaron fueron resistentes a ACSSuT, 52,0 por ciento (287) fueron resistentes a uno o más antibióticos del grupo ACSSuT y 27,1 por ciento (150) no fueron resistentes (es decir, fueron sensibles a dichos antibióticos). Según el análisis, la resistencia general a los antibióticos fue muy alta en la década de 1970 (y comprendió a 99,0 por ciento de los aislados de ese período) y continuó siendo alta durante la década de 1980, cuando 95,4 por ciento de los aislados presentó algún tipo de resistencia a los antibióticos y la incidencia de Salmonella serovariedad Typhimurium DT193 con resistencia de tipo ACSSuT aumentó hasta 73,8 por ciento. La resistencia de tipo ACSSuT descendió a 27,1 por ciento (31 aislados) durante la década de 1990, y a 5,2 por ciento (17 aislados) entre el 2000 y el 2008, a pesar del aumento importante en el número de aislados que se evaluaron (397 frente a 204, 111 y 98 en las tres décadas anteriores, respectivamente). CONCLUSIONES: Aunque la prevalencia de Salmonella serovariedad Typhimurium DT193 con resistencia de tipo ACSSuT en el Brasil ha disminuido desde la década de 1970, los marcadores de resistencia a ACSSuT continúan en circulación. Por consiguiente, debe llevarse a cabo una vigilancia permanente para evaluar la aparición de infecciones por Salmonella serovariedad Typhimurium DT193 y su resistencia a los antibióticos.

Avaliação da suscetibilidade antimicrobiana e do perfil de macrorrestrição do DNA de isolados humanos de Salmonella serovar Typhimurium fagotipo 193, no período de 1970 a 2008 / Assessment of antimicrobial susceptibility and macrorestriction DNA of human isolates of Salmonella serovar typhimurium phage type 193 in the period 1970 to 2008

Para analisar cepas de Salmonella ser. Typhimurium isoladas de processos entéricos e extraintestinais humanos ocorridos no período de 1970 a 2008 de diferentes regiões do país foram selecionadas, com base nos registros contidos no banco de dados do Laboratório de Enterobactérias do IOC/FIOCRUZ, RJ, amostras do fagotipo prevalente 193, visando precipuamente o reconhecimento de clones epidêmicos. Foram selecionadas 553 cepas de Salmonella ser. Typhimurium fagotipo 193 representadas por 91, 65, 70 e 327 amostras referentes as décadas de 70, 80, 90 e ao período de 2000 a 2008, respectivamente. Na análise global da sensibilidade destas cepas, 52% apresentaram um ou mais marcadores de resistência a antibióticos incluídos no perfil ACSSuT. Este perfil de resistência completo foi verificado em 20,9% dos isolados, sendo os 21,9% restantes, sensíveis a todas as drogas testadas, especialmente no período de 2000 a 2008, representadas por 121 amostras (37,0%) em relação as 327 culturas dessa época. O maior percentual de resistência foi observado nas amostras da década de 70 (99%) sendo o perfil ACSSuT detectado em 35,2% dos isolados, ressaltando-se que todas as amostras foram isoladas de processos gastroentéricos ocorridos na cidade de São Paulo. Ao longo das quatro décadas de estudo, descreve-se um ponto de ruptura entre a prevalência de resistência e a suscetibilidade na transição entre as décadas de 80 e 90. Embora o número de isolados de Salmonalla ser. Typhimurium fagotipo 193 tenha aumentado no último período considerado, o percentual de mono e multirresistência aos antimicrobianos se situou em nível elevado (63,0%). A análise do polimorfismo obtido após macrorrestrição com a enzima Xbal revelou que cepas isoladas na década de 90 apresentaram elevado percentual de similaridade (>-85%) com cepas isoladas recentemente (período de 2000-2008), sendo agrupadas nos mesmos "subclusters". Por outro lado, as cepas da década de 70 inserem-se em "subclusters" independentes...

To analyze strains of Salmonella ser. Typhimurium isolated from human cases of enteric and extraintestinal occurred during the period 1970 to 2008 of different regions of Brazil were selected, based on records in the database from Enterobacteria Laboratory of IOC/FIOCRUZ, RJ, samples prevalent phage type 193 in order to recognition of epidemic clones. We selected 553 strains of Salmonella ser. Typhimurium phage type 193 represented by 91, 65, 70 and 327 samples concerning the 1970s, 1980s, 1990s and the period from 2000 to 2008, respectively. In a global analysis of the sensitivity of these strains, 52% had one or more antibiotic resistance markers included in the profile ACSSuT. This resistance profile was found complete in 20.9% of isolates and the remaining 21.9%, sensitive to all drugs tested, especially in the period 2000 to 2008, represented by 121 samples (37.0%) compared the 327 cultures of that time. The highest percentage of resistance was observed in the samples of the 70 (99%) being the profile ACSSuT detected in 35.2% of isolates, emphasizing that all strains were isolated from gastrointestinal processes occurring in São Paulo city. Over the four decades of study, we describe a breaking point between the prevalence of resistance and susceptibility in the transition between the 1980s and 1990s. Although the number of isolates of Salmonella ser. Typhimurium phage type 193 has increased in the last period, the percentage of mono-and-multidrug resistance to antimicrobial agents stood at high level (63.0%). The analysis of polymorphism obtained after macrorestriction with the enzyme Xbal showed that isolates in the 1990s showed a high percentage of similarity (>-85%) with strains isolated recently (2000-2008) and are grouped in the same subclusters. Moreover, the strains of the 1970s fall into subclusters independent, although the percentage of similarity between such subsclusters and the other is >- 70%, the same was observed for the strains...

Antimicrobial susceptibility and pulsed - field gel electrophoretic analysis of salmonella in a tertiary hospital in northern Malaysia

Salmonella infections remain a major public health problem in developing countries. The occurrence of infections caused by antimicrobial-resistant Salmonella has been on the rise complicating the available therapeutic options. The study aimed to determine the antibiograms and genotypes of prevalent Salmonella serotypes. A retrospective study involving 80 stool and extra-intestinal Salmonella strains collected over a 18-month period [January 2005-June 2006] from a tertiary hospital in Penang, Malaysia was conducted. Isolates were examined for resistance to 14 antimicrobial drugs and the clonality of the strains was determined by PFGE. Twenty-one serotypes were identified, the most common being S. enteritidis [42.5%] followed by S. corvallis [11.25%] and S. braenderup [11.25%]. S. enteritidis was significantly more common amongst the extra-intestinal isolates compared to stool isolates [74.2% versus 22.4%, p < 0.0001]. Overall, the highest resistance was observed for tetracycline [66.3%], sulphonamides [56.3%], streptomycin [32.5%], trimethoprim [28.8%] and nalidixic acid [27.5%]. Amongst the 31 invasive extra-intestinal isolates, resistance towards therapeutically relevant antibiotics was as follows: co-trimoxazole [38.7%], ampicillin [29%] and ceftriaxone [3.2%]. Although there was no detectable resistance towards chloramphenicol and ciprofloxacin, 29% strains showed nalidixic acid resistance. About 41% of the 80 isolates were multidrug-resistant. PFGE subtyped the 78 Salmonella isolates to 33 distinct XbaI-pulsotypes. Isolates within the serotypes S. enteritidis, S. corvallis, S. branderup and S. fasta were more homogeneous while S. typhi and S. weltervden were genetically more diverse. The high percentage of multidrug-resistant Salmonella strains is worrying and is of public health concern. PFGE was a useful and discriminative method for assessing the genetic diversity of Salmonellae

Empiema causado por Salmonella typhimurium / Pleural empyema caused by Salmonella typhimurium: a case report

Salmonella species are commonly associated with acute gastroenteritis due to ingestion of contaminated food or water. Extraintestinal infections are less frequent, and most of them occur in immunocompromised patients. We report a case of pleural empyema caused by Salmonella typhimurium, without previous diarrhea or fever. The patient evolved favorably after receiving adequate treatment.

El género Salmonella se caracteriza por causar infecciones en el tracto gastrointestinal, debido a la ingesta de alimentos o agua contaminada. También puede causar, con menor frecuencia, infecciones localizadas en diferentes órganos; esto se asocia con inmunodepresión. En este caso se describe un paciente con infección pleuropulmonar por Salmonella typhimurium, que no reportó antecedentes de diarrea previa. Evolucionó favorablemente con tratamiento adecuado.

Salmonella non typhoidique : une cause rare d'infection urinaire

Le but de notre travail est d'analyser les aspects cliniques; bacteriologiques et therapeutiques des infections urinaires a Salmonella non typhi (SNT) dans notre region. Patients et methodes : Il s'agit d'une etude descriptive retrospective ayant concerne les cas d'infections urinaires a SNT diagnostiques a l'hopital Sahloul (Sousse; Tunisie) recenses sur une periode de six ans et demi (Janvier 2003-Juin 2009). Les souches ont ete identifiees grace a leurs caracteres morphologiques; biochimiques et antigeniques. Un antibiogramme a ete effectue. Resultats : 9 cas d'infection urinaire a SNT ont ete ainsi recenses; soit 0;079des infections urinaires colligees au laboratoire de microbiologie durant la meme periode. L'age moyen des patients etait de 45 ans. Un terrain debilite etait note chez 8 des 9 patients. Les facteurs favorisants notes etaient variables et parfois associes chez un meme patient: diabete (4 cas); traitement corticoide et immunosuppresseur (3 cas); insuffisance renale (3 cas); reflux vesico-uretral (1 cas); pathologie tumorale (4 cas); lupus erythemateux systemique (1 cas); hypertrophie prostatique (1 cas). Les serotypes notes etaient Salmonella enteritidis (8 cas); Salmonella typhimurium (1 cas). L'evolution sous antibiotherapie adaptee (duree moyenne de 16.4 jours) etait favorable dans 7 cas. Conclusion : L'infection urinaire a SNT survient en regle sur un terrain predispose notamment un diabete sucre; une uropathie ou un etat d'immunodepression. Le traitement antibiotique doit etre suffisamment prolonge pour eviter les complications et les recidives

Evolución de los serotipos, fagotipos y resistencia a antimicrobianos de Salmonella sp en el departamento de salud 02 de la provincia de Castellón, España (2000-2006) / Evolution of serotypes, phagotypes and antibiotic resistance of Salmonella spp in the 02 health district of Castellón, Spain (2000-2006)

Retrospective study of serotypes, phage types and antibiotic resistance of Salmonella spp isolates in the 02 Health District of Castellón, Spain (2000-2006). Strains were serotyped using commercial sera, and they were tested for antimicrobial susceptibility with automated systems. Serotyping confirmation and phage typing were performed by the National Reference Laboratory. A total of 1505 strains were isolated, with 49 different serotypes, being the most frequent Enteritidis. The most common serotype/phage type combination was S. Enteritidis phagetype 1. Of the isolates 81.6 percent were susceptible to amoxicillin/clavulanic acid; 65.2 percent to ampicilin; 99.9 percent to ciprofloxa-cin; 93.4 percent to trimethoprim-sulphametoxazole; and 99.8 percent to cefotaxime. Molecular methods could be useful to complete epidemiologic studies since 25 percent of our isolates showed the same serotype/phage type combination. In our health district antimicrobial resistance in Salmonella is not an important problem.

Salmonella typhimurium outbreak in a neonatal unit in Turkey.

Objective. To analyze an outbreak caused by a multipl resistant strain of S. typhimurium in a newborn unit in Turkey. Methods. The outbreak occured during the period 15 to 29 March,2005. A newborn infected with S. typhimurium was defined as a case. Newborns who were hospitalized during the outbreak period with no diagnosis of S. typhimurium infections (n=50) constituted the control group I (CG I). The matched patients of the control group II (CG II) (n=20) were selected from neonates without S. typhimurium infections during the period. Results. Of 22 infants who were affected two died. Cases developed diarrhea (n=20), septicemia (n=5) and meningtis (n=1). The strain was resistant to ampicillin, ceftriaxone, ceftazidime, amikacin, trimethoprim-sulfamethoxasole and chloromphenicol, susceptible to meropenem. All of the infected neonates were treated with meropenem. The surveillance cultures were negative. The outbreak was controlled by approprite therapy and institution of effective control measures. The cases were more exposed to mechanical ventilation than CG I (p<0.05). The mean additional length of stay in cases was significantly different from CG II (14.9 days vs. 5.1 days, p<0.05). The mean charges was $1588.78 for a case and $506.94 for a control (P<0.05). Accommodation accounted for 44.5% of these extra charges. Conclusion. This study increases the understanding of the burden of multidrug-resistant S. typhimurium infection. Nosocomial outbreaks have a major effect on healthcare delivery, costs and outcomes.

Serovar distribution and antibiotic susceptibility of nontyphoidal Salmonella isolated from pediatric patients in Jakarta, Indonesia.

A study was conducted during January 2003 through August 2005, at two community health centers in south Jakarta, Indonesia, to detect nontyphoidal Salmonella infections in children with diarrhea. A total of 814 rectal swab samples were collected, of which 56 (6.9%) were positive for Salmonella. Among the serovars detected, Salmonella enterica serovar Typhimurium was found most frequently in 32.1% of all Salmonella isolates. Antimicrobial susceptibility testing using eight antibiotics showed 5.6% to 66.7% of Salmonella serovars resistant to ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol, tetracycline, and nalidixic acid. However, all serovars were susceptible to norfloxacin, ciprofloxacin, and ceftriaxone.

Salmonellosis in Lagos, Nigeria: incidence of Plasmodium falciparum-associated co-infection, patterns of antimicrobial resistance, and emergence of reduced susceptibility to fluoroquinolones.

The present study was undertaken to examine the status of antimicrobial resistance in Salmonella-associated diseases, by verifying possible emergence of reduced susceptibility to fluoroquinolones in Salmonella isolates and determining the incidence of Plasmodium falciparum-associated co-infection with Salmonella serotypes. Antimicrobial resistance in clinical isolates of Salmonellae was examined for a 12-month period. Four hundred and forty-one patients comprising two groups were recruited. Group A comprised 235 patients diagnosed by clinicians of having pyrexia, and group B included stool samples of 206 patients presenting with gastroenteritis. Samples were cultured and isolates identified, and drug susceptibility testing was performed using the standard methods. Of the 235 samples screened in group A, 42 Salmonella isolates and 107 Plasmodium spp. were identified. Of the 42 Salmonella isolates, 19 (45.2%) were Salmonella Typhi, 9 (21.4%) S. Enteritidis, and 7 (16.7%) each of S. Paratyphi and S. Arizonae. Plasmodium spp.-associated co-infection with Salmonellae was observed in 16 patients mostly in complicated typhoidal cases and S. Enteritidis-associated bacteraemia. Fifty-three of the 206 stool samples from group B patients were confirmed positive for bacterial pathogens, made up of 35 Salmonella and 18 Shigella isolates. Of the Salmonella isolates, 18 (51.4%) were S. Enteritidis, 11 (31.4%) S. Arizonae, 4 (11.4%) S. Paratyphi, and 2 (5.7%) S. Typhi. There was no statistically significant difference (p < 0.01) in antimicrobial resistance patterns exhibited among typhoidal Salmonellae isolated in 2000 and 2005. A similar trend in resistance was recorded for non-typhoidal Salmonellae (p < 0.05). For the first time in Lagos, Nigeria, Salmonella isolates (10-18%) with reduced susceptibility to both ciprofloxacin and ofloxacin at MIC50 and MIC90 values of 0.015 and 0.03 microg/mL respectively were found. Despite this development, ciprofloxacin and ofloxacin remain the drug of choice for severe cases of salmonellosis, although caution should be exercised by clinicians in their prescriptions such that fluoroquinolone antibiotic therapy is used only in laboratory-proven cases of typhoid fever and Salmonella-associated bacteraemia to preserve its efficacy.