Cardiac Involvement in Travelers with Enteric Fever.

Data regarding cardiac involvement in enteric fever among travelers are scarce. In this retrospective study, 59 patients were hospitalized with enteric fever during 2004-2017 and 28 had cardiac workups. Among those, four had evidence of cardiac involvement, including clinical myocarditis, electrocardiogram changes, or troponin elevation. Cardiac involvement was higher among patients infected with Salmonella Typhi than with Salmonella Paratyphi A (P = 0.08), with a significant relative risk of 6 (95% CI: 1.15-31.22, P = 0.03). Time from symptoms onset to effective treatment was longer for patients with cardiac involvement (13 versus 7.15 days, P < 0.05). It seems that cardiac involvement in enteric fever is not uncommon in travelers. Such involvement seems to be more common in patients with delay of effective treatment to the second week of illness. Although fatal or complicated cases are rare in travelers, the cardiac complication may be an important contributor to morbidity and mortality in this group.

Subdural empyema due to Salmonella paratyphi B in an infant: a case report and review of literature.

Intracranial infection due to Salmonella is uncommon in children. Subdural empyema (SDE) is described with Salmonella typhi as a complication of meningitis. We report a 6-month-old infant with SDE secondary to Salmonella paratyphi B who had presented with prolonged fever and enlarging head. A literature review of Salmonella SDE in infants with respect to clinical course and outcome is presented.

Successful endoscopic hemoclipping of massive lower gastrointestinal bleeding from paratyphoid A fever.

Paratyphoid fever can be complicated by massive lower gastrointestinal bleeding with ileocolonic ulcerations, which are commonly localized using colonoscopy. The most common manifestations include multiple, variable-sized, round or oval-shaped, punched-out ulcers. Occasionally, massive lower gastrointestinal bleeding can occur from erosion of blood vessels. We present a rare case of severe lower gastrointestinal bleeding due to paratyphoid A fever that was successfully controlled with hemoclippings. A 30-year-old man experienced high fever and hematochezia whose blood culture showed Salmonella paratyphi A. A complete colonoscopy was successfully performed up to the level of the terminal ileum, which showed multiple, shallow, ulcerated lesions over the entire terminal ileum. A bleeding vessel was seen in one of the ulcers, with overlaying blood clots. Endoscopic hemostasis was successfully performed with four pieces of endoclip and without immediate complication. This report highlights the use of colonoscopy and endoscopic therapy with endoclips for lower gastrointestinal bleeding, which should be considered before surgery.

Evolución de brotes epidémicos causados por salmonellaspp., en la Región de Murcia (2003-2013 / Evolution of outbreaks caused by salmonellaspp., in the Region of Murcia (2003-2013)

Introducción: A lo largo del presente trabajo se han revisado datos anuales de enfermedades causadas por cepas del género Salmonellaspp., tanto en áreas de salud, en municipios de la Región de Murcia; así como la evolución de estas enfermedades desde 2003 hasta 2013. También se ha estudiado la distribución de los casos por ámbito general y familiar, así como los casos de fiebre tifoidea y fiebre paratifoidea. Métodos: Se han seleccionado estudios publicados en revistas incluidas en Index Citation Reports. Igual - mente se consultaron documentos procedentes del Boletín Epidemiológico de la Región de Murcia y campañas encaminadas a la prevención de enfermedades de declaración obligatoria. Resultados: Salmonellaspp., es el agente causal identificado en 122 brotes (53 de ámbito general, 63 de ámbito familiar y 6 de origen desconocido) y con un total de 1989 afectados por toxiinfecciones alimentarias. Entre los alimentos implicados encontramos en primer lugar el huevo provocando 74 brotes, seguido de la carne y productos cárnicos (18 brotes), crustáceos (15 brotes), pescado y derivados de pescado (12 brotes). Durante los 10 años objeto de estudio, se dieron 37 casos de fiebre tifoidea y paratifoidea, de estos 37 casos, 15 se dieron en varones, 19 en mujeres y 3 en género desconocido por falta de datos. Discusión: Los datos analizados en el presente trabajo, abordan la evolución de brotes de toxiinfecciones alimentarias causadas por cepas del género Salmonellaspp., durante el período que comprende desde 2003 a 2013 en la Región de Murcia. Los resultados obtenidos nos han permitido identificar los ámbitos familiar y general como los que presentan mayor número de brotes. Los brotes causados por Salmonella typhi, y Salmonella paratyphi han ido en un claro descenso gracias a las sanciones y medidas de prevención. Sin embargo, en la Región de Murcia no se han elaborado campañas de prevención que tengan presente sobre todo el ámbito familiar. Por otro lado, los centros declarantes de atención especializada presentaron una cobertura sanitaria desigual, por lo que marca líneas donde es necesario mejorar el protocolo de notificación. Conclusiones: Las sanciones interpuestas en la Región de Murcia han permitido reducir en los 11 años objeto de estudio y de manera significativa el número de brotes por toxiinfecciones alimentarias, donde el agente responsable mayoritario es Salmonellaspp. Los datos sobre cobertura sanitaria obtenidos en algunos municipios, ponen de manifiesto la necesidad de mejorar el sistema de notificación. También exigen una colaboración de los servicios municipales de salud y el Servicio de Epidemiología de la Consejería de Sanidad, con el fin de corregir las limitaciones existentes (AU)

Summary: Throughout this article we show data from diseases caused by Salmonella spp strains and also we reviewed in both health and councils areas in the Region of Murcia. We studied the evolution of these diseases from 2003 to 2013. We analyzed the distribution of cases by general and familiar ranges and cases of typhoid and paratyphoid fever as well. Methods: We selected journals articles included in the Index Citation Reports. We also reviewed data from the Epidemiological Bulletin of the Region of Murcia and informative campaigns oriented to prevention of notifiable diseases. Results: Salmonellaspp. was identified in 122 outbreaks (53 general cases, family cases 63 and 6 unknown) with a balance of 1989 cases. Food like egg caused 74 outbreaks, followed by meat products (18 outbreaks), shellfish (15 outbreaks), fish and processed fish (12 outbreaks). In the last 11 years were detected 37 cases of typhoid and paratyphoid fever. 15 have occurred in men, 19 in women and 3 unknown genders. Discussion: Data showed the evolution of foodborne diseases outbreaks caused by Salmonellaspp. strains during 2003-2013 in the Region of Murcia. The highest number of outbreaks took place in familiar and general ranges. Outbreaks caused by Salmonella typhi and Salmonella paratyphi declined due to sanctions and preventive measures. However, in the Region of Murcia has not developed preventive campaigns aimed at avoid outbreaks in family range. On the other hand, specialized care centers showed uneven health coverage, for that reason is necessary to improve the notification procedure. Conclusions: In the Region of Murcia sanctions in the last 11 years reduced the number of foodborne diseases outbreaks and Salmonellaspp. was the most frequently isolated agent. Health coverage data make evident why is required to improve the reporting system. They also demand collaboration of council health services and Epidemiology Service of the Ministry of Health, in order to correct the current limitations (AU)

Salmonella paratyphi A-infected ovarian cyst in returning traveller--an unusual complication of enteric fever.

We report a case of Salmonella paratyphi A enteric fever in a returned New Zealand traveller complicated by an infected ovarian cyst, which resulted in clinical and microbiological relapse despite appropriate antibiotic treatment. Extraintestinal manifestations of enteric fever are infrequent but should be considered in situations where treatment response to first-line antibiotics for adequate duration is suboptimal.

Recurrent paratyphoid fever A co-infected with hepatitis A reactivated chronic hepatitis B.

We report here a case of recurrent paratyphoid fever A with hepatitis A co-infection in a patient with chronic hepatitis B. A 26-year-old male patient, who was a hepatitis B virus carrier, was co-infected with Salmonella enterica serovar Paratyphi A and hepatitis A virus. The recurrence of the paratyphoid fever may be ascribed to the coexistence of hepatitis B, a course of ceftriaxone plus levofloxacin that was too short and the insensitivity of paratyphoid fever A to levofloxacin. We find that an adequate course and dose of ceftriaxone is a better strategy for treating paratyphoid fever. Furthermore, the co-infection of paratyphoid fever with hepatitis A may stimulate cellular immunity and break immunotolerance. Thus, the administration of the anti-viral agent entecavir may greatly improve the prognosis of this patient with chronic hepatitis B, and the episodes of paratyphoid fever and hepatitis A infection prompt the use of timely antiviral therapy.

Spontaneous bacterial peritonitis caused by S. paratyphi A.

Spontaneous (primary) bacterial peritonitis (SBP) due to S. paratyphi A is relatively uncommon. Clinical manifestations of SBP vary widely from severe to slight or absent, necessitating laboratory investigation of ascitic fluid. The disease is confirmed by number of neutrophils > 250/mm3 associated with or without bacterial growth in ascitic fluid culture from diagnostic abdominal paracentesis. Here, we present a case of S. paratyphi A SBP occurring in a patient with chronic liver disease and portal hypertension.The patient was treated with intravenous cefotaxime with good clinical response.

A case report of acute acalculous cholecystitis due to Salmonella Paratyphi B complicated by biliary peritonitis.

Non-typhoidal salmonella are a rare case of acute acalculouscholecystitis (AAC). Salmonella Paratyphi B, which accounts for one of the less invasive NTS serotypes, has rarely been reported to cause cholecystitis. We describe a case of 65-year old previously healthy man, who present with signs of acute abdomen, due to biliary peritonitis as a complication of acute acalculouscholecystitis caused by Salmonella paratyphi B. Our case illustrates the potential severity of infection with Salmonella Paratyphi B especially in older patient. High index of awarenessshould be considered in endemic areas.

Bickerstaff's brainstem encephalitis complicating Salmonella Paratyphi A infection.

Patients with enteric fever frequently develop neurological complications during their illness. Among them, majority has encephalopathy, but focal deficits or peripheral nervous involvements are occasionally encountered. We describe a young woman who developed a neurological syndrome consistent with Bickerstaff's brainstem encephalitis, with symptoms and signs including convulsion, impaired consciousness, external ophthalmoplegia, ataxia, bulbar palsy and pyramidal signs, following Salmonella Paratyphi A infection. This is the first case report of this syndrome after S. Paratyphi A infection, and it is the second case of Bickerstaff's brainstem encephalitis complicating enteric fever reported in the literature. This case also demonstrated, for the first time, a positive anti-GQ1b IgG response in a patient with Bickerstaff's brainstem encephalitis and related disorders that appear as complications during enteric fever.

Small bowel perforation secondary to enteric Salmonella paratyphi A infection.

A patient of Pakistani-origin was admitted to Bradford Royal Infirmary, UK, following a 3-week history of cough, headache and general malaise. He had recently spent 10 weeks in Pakistan and on return had been diagnosed in the community with Swine flu. He developed abdominal pain and diarrhoea in the week prior to admission, and presented to hospital with fever, tachycardia and raised inflammatory markers. He deteriorated rapidly, developing signs of peritonism and Salmonella paratyphi A was grown from blood cultures. CT demonstrated a small volume of free fluid within the abdomen and the patient underwent laparotomy. A small bowel perforation was resected and a side to side anastomosis fashioned. Treatment with intravenous antibiotics was completed and the patient was discharged 9 days postoperatively.