Title : Rare focal infections by nontyphoidal salmonella: A case series of unusual presentations
Abstract:
Salmonella enterica serovar Typhimurium is a globally prevalent pathogen that is the most common bacterial cause of foodborne-related illness in the United States. This bacterium is part of the colon normal flora of many animals, including humans and other mammals, birds (especially domesticated poultry), reptiles, and amphibians. This microbe is usually limited to the large intestine; rarely will nontyphoidal Salmonella disseminate. When it does, it tends to cause focal infections. In contrast, Salmonella enterica serovars Typhi and Paratyphi are human-only pathogens that cause disseminated and potentially fatal typhoid fever. Our case report highlights three rare cases of focal abscess formation caused by nontyphoidal Salmonella in patients without specific risk factors or recent documented intestinal infection.
Case 1 involves a 71-year-old male who developed a lumbar epidural abscess following a lumbar 3-4, 4-5 laminectomy. Case 2 follows the care of a 41-year-old male with a previous diagnosis of Salmonella pneumonia and sepsis presenting with hepatic and psoas abscesses following an assault. Case 3 details a 66-year-old male with amyotrophic lateral sclerosis and a mechanical aortic valve who was directly admitted with sepsis caused by Salmonella with a concurrent myocardial infarction. These cases underscore the unusual infectious potential of Salmonella enterica serovar Typhimurium. Rapid identification and intervention are critical in these cases to prevent further dissemination and severe outcomes such as endocarditis. The optimal treatment of Salmonella Typhimurium abscesses remains case dependent. Many of these focal infections occur in immunodeficient patients and may result due to a continued infection. However, as indicated in our cases, immunocompetent individuals may still experience Salmonella abscesses, even in the absence of recent intestinal infection. Due to the high mortality rate and risk of severe infection associated with many of these presentations, continued documentation of clinical characteristics and treatment is imperative.
