Síndrome disentérico, insuficiencia renal aguda y shock séptico letal asociados a infección por salmonella enteritidis: descripción de 3 casos / Dysentery, acute renal failure and septic shock caused by salmonella enteritidis: report of 3 cases

RESUMO

Chile is being affected by an epidemic of S enteritidis infections since 1994, an increasingly important cause of morbidity wordwide. Although infections by this bacteria have been commonly associated ti diarrhea and patients are usually not affected by complications, three patients required admission by dysentery (not reported in most published series), acute renal failure (ARF) and septic shock (SS), respectively, at the end of the summer season. S enteritidis was isolated from stool cultures in all three cases. A female patient (24) with dysentery presented with fever and diarrhea associated with blood and mucus and localized abdominal pain in the lower right quadrant. Surgery was not required although laparotomy was considered in the first hours after admission. ARF was demonstrated in a male patient (50) by dehidration, increased creatinine plasma and BUN level (7,19 and 103 mg/dl, respectively), and increased urinary Na level and anion gap (35 mEq/l). Hemodialysis was not required. A third patient was admitted by SS (male, 57, alcoholic), as demonstrated by hypotension despite fluid reposition, altered mental status, and multiorgan compromise. Haemodynamic monitorization showed a high cardiac index and a low systemic vascular resistence. CPK serum determinations indicated rhabdomyolysis. Patients recovered satisfactorily, except SS patient, who died