Letters to the Editor

Indian Pediatrics 2001; 38: 205-206

Salmonella enteritidis Meningitis in an Infant

Infections caused by Salmonella enteri-tidis serotype Enteritidis are prevalent world-wide causing disease ranging from a benign self limiting diarrheal illness and food poison-ing to generalized and severe infections such as septicemia, endocarditis, empyema and meningitis. Meningitis caused by Salmonella enteritidis is associated with high mortality (20-40%) and adverse neuro-developmental sequelae among 50-70% of survivors(1). Most of the documented cases originate from countries with excellent surveillance systems for Salmonella but such occurrences have been rarely reported from the Indian sub-continent(2). We present a sporadic case of pyogenic meningitis caused by S. enteritidis in a 7 month old girl.

The child presented with watery diarrhea, vomiting, and fever for two days followed by a generalized tonic clonic seizure. Examina-tion revealed a malnourished, febrile, cons-cious infant. Anterior fontanelle was bulging. There were no meningeal signs or neuro-logical deficit. Total leukocyte count was 20,000 per cu mm with 80% polymorphs. Peripheral smear revealed toxic granulations. Serum urea and electrolytes were normal. Lumbar puncture revealed turbid cerebro-spinal fluid under normal tension. CSF microscopy showed 2500 cells per cu mm with 90% polymorphs. CSF protein was 144 mg/dl and sugar 20 mg/dl (with a corres-ponding blood sugar of 59 mg/dl). Culture demonstrated a pure growth of Salmonella enteritidis sensitive to cefotaxime, genta-micin, chloramphenicol, and ciprofloxacin. Blood and stool cultures did not reveal any pathogenic organism. The child responded well to a two week therapy with intra- venous cefotaxime without any immediate complications.

The case described here had an episode of diarrhea followed by seizures. The dignostic considerations in such cases include dyselectrolytemia, encephalopathy, meningo-encephalitis and cerebral venous thrombosis. Demonstration of S. enteritidis in CSF was intriguing as simultaneous cultures from blood and stool did not reveal the organism. This organism is transmitted to humans by consumption of contaminated poultry products. Large outbreaks have been reported from different parts of world including UK and USA where a robust surveillance system for salmonella is in operation(3,4). Although considered to be a disease of the indus-trialized world due to its mode of transmission by eggs, processed poultry and food products; yet in many areas of developing world, Salmonella species account for more than 50% Gram negative enteric organisms isolated from CSF(5).

Surprisingly, no outbreak of S. enteritidis has been reported from India although the organism has been isolated frequently by the Central Research Institute, Kasauli, from both animal and human sources(6). Relatively, infrequent isolation of S. enteritidis may not be due to rarity of the infection but could be due to lack of a well established surveillance system for Salmonella infections in India.

S. enteritidis is a potentially dangerous zoonotic infectious agent and causes pro-longed symptomless excretion after infection particularly in immunocompromised subjects and infants(7). Such cases may therefore serve as a potent source of infection in the community. This, however, could not be documented in the present case and the child was lost to follow up. Sporadic cases like this should also forewarn the epidemiologists and alert the health managers for a need to develop proper case detection and vigilance strategy for all Salmonella infections.

Nisha Gupta,
Piyush Gupta,
Department of Pediatrics,
University of College of Medical Sciences,
Delhi 110 095, India.
E-mail: [email protected]

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7. Balfour AE, Lewis R, Ahmed S. Convalescent excretion of Salmonella enteritidis in infants. J Infect 1999; 38: 24-25.