Salmonella typhimurium myopericarditis: A case report and review of literature

BACKGROUND Non-typhoidal salmonella(NTS)is a rare,but well-established cause of myopericarditis.Presenting symptoms may be varied,however often revolve around the dual presentation of both myopericarditis and infectious diarrhoea.Given the rarity of NTS related myopericarditis,we conducted a systematic review of the literature,identifying 41 previously reported cases.CASE SUMMARY We present the case of an otherwise healthy 39-year old male,presenting with chest pain in the setting of documented Salmonella typhimurium infection.After further investigation with echocardiogram and laboratory blood tests,a diagnosis of NTS associated myopericarditis was made,and the patient received antibiotic treatment with an excellent clinical outcome.Overall,myopericarditis is rare in NTS.Although treatment for myopericarditis has not been well established,there are guidelines for the treatment of NTS infection.In our review,we found that the majority of NTS cases has been pericarditis(27/42,64.3%),with an average age of 48.3 years,and 71.4%being male.The average mortality across all cases was 31%.CONCLUSION Myopericarditis is a rare,but potentially serious complication of NTS infection,associated with an increased morbidity and mortality.

Unusual cause of hemorrhagic pleural effusion:A case report

BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat.We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone.However his condition did not improve,and he developed a multiloculated right pleural effusion.Thoracocentesis was done to drain hemorrhagic pleural fluid.Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity.He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage.He completed intravenous antibiotic for 5 wk and refused surgical intervention.Unfortunately,he was admitted twice for recurrent nontyphoidal Salmonella bacteremia.Finally,he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later.Postoperatively,his condition remained stable with no recurrence of infection.CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.

Salmonella Berta myocarditis:Case report and systematic review of non-typhoid Salmonella myocarditis

AIM: To study trends in the epidemiology,clinical presentation,microbiology and prognosis of nontyphoid Salmonella(NTS) myocarditis.METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation,electrocardiogram(ECG) changes,transthoracic echocardiographic findings,cardiac magnetic resonance findings,microbiology cultures,Salmonella species,inflammatory markers(erythrocyte sedimentation rate and C-reactive protein),cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases(defined as < 18 years old) and adult cases(defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics(Windows,Version 20.0. Armonk,NY: IBM Corp.) for demographic characteristics,presenting symptoms,microbiology,diagnostic methods,treatment modalities and outcome.RESULTS: From the selected articles,we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years(range 1 mo-67 years),16% of cases were children aged < 18 years. Most patients presented with chest pain,fever,and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia(40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group(100% vs 63.1%). Eightythree percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.

Severe Infant Meningoencephalitis Caused by Salmonella Apeyeme: A Case Report

Salmonella enterica serovar Apeyeme is a rare pathogen that primarily affects poultry.However,there are limited data about this infection in humans.In this case,a 7-month-old infant presented with high-grade fever without diarrhea for 12 hours prior to admission.Upon admission,he developed seizures and was referred for further intervention.He was diagnosed with meningoencephalitis with complications of subdural effusion,empyema,and abscesses.Salmonella Apeyeme was found in cerebrospinal fluid culture,but no growth was detected in either blood or stool cultures.He was given meropenem,vancomycin,and ciprofloxacin,but later developed disseminated intravascular coagulation.His clinical condition deteriorated over time,and he died 18 days after admission.To conclude,Salmonella Apeyeme infection should be considered if a patient is diagnosed with meningoencephalitis and has a history of poultry exposure.