Salmonella enterica serotype Choleraesuis: a rare pathogen isolated from perianal abscess.

Infections with non-typhoidal salmonella (NTS) most commonly cause localised infections such as cutaneous abscesses in humans and are a leading source of foodborne illness. Here, we present a unique case of NTS Choleraesuis in a perianal abscess in an immunocompetent patient without any comorbidities.A woman in her late 40s was diagnosed with a perianal abscess with an unknown origin of infection. The patient has undergone an incision and drainage. Her pus culture and sensitivity report yielded Salmonella enterica serotype Choleraesuis. Then, the patient recovered after treatment with intravenous antibiotics and supportive treatment.We present an unusual case of S. enterica serotype Choleraesuis, which is rarely reported as a causative agent of perianal abscess in India. This case has been reported for its rarity in India.

Nontyphoidal Salmonella Outbreaks Associated With Chocolate Consumption: A Systematic Review.

BACKGROUND: A large, cross-border outbreak of nontyphoidal salmonellosis connected to chocolate product consumption was recently reported. This occurrence motivated us to conduct a comprehensive review of existing literature concerning outbreaks of nontyphoidal salmonellosis associated with chocolate consumption. METHODS: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42022369023) in 3 databases: U.S. National Library of Medicine, Web of Science and Excerpta Medica. Google Scholar and the bibliography of each identified report were also screened. Eligible were articles published after 1970, describing outbreaks of more than 10 patients with a nontyphoidal salmonellosis associated with chocolate consumption. RESULTS: Twenty-three articles were included, which described 12 outbreaks involving a total of 3266 patients. All outbreaks occurred in high-income countries: 1 was limited to 1 city, 6 involved 1 country and the remaining 5 involved 2 or more countries. Six outbreaks peaked in winter, 3 in autumn, 2 in spring and 1 in summer. Children were mainly affected. No predominant serotype was identified. CONCLUSIONS: Our data documents that chocolate is an optimal medium for the transmission of nontyphoidal salmonellosis. A connected worldwide reporting system including high-income, middle-income and low-income countries is crucial to detect infectious diseases outbreaks in an early phase and avoid their spread.

Rapid Dot-Blot Immunoassay for Detecting Multiple Salmonella enterica Serotypes.

Salmonella, a major contributor to foodborne infections, typically causes self-limiting gastroenteritis. However, it is frequently invasive and disseminates across the intestinal epithelium, leading to deadly bacteremia. Although the genus is subdivided into >2,600 serotypes based on their antigenic determinants, only few serotypes are responsible for most human infections. In this study, a rapid dot-blot immunoassay was developed to diagnose multiple Salmonella enterica serotypes with high incidence rates in humans. The feasibility of 10 commercial antibodies (four polyclonal and six monoclonal antibodies) was tested using the 18 serotypes associated with 67.5% Salmonella infection cases in the United States of America (U.S.A) in 2016. Ab 3 (polyclonal; eight of 18 serotypes), Ab 8 (monoclonal; 13 of 18 serotypes), and Ab 9 (monoclonal; 10 of 18 serotypes) antibodies exhibited high detection rates in western blotting and combinations of two antibodies (Ab 3+8, Ab 3+9, and Ab 8+9) were applied to dot-blot assays. The combination of Ab 3+8 identified 15 of the tested 18 serotypes in 3 h, i.e., S. Enteritidis, S. Typhimurium, S. Javiana, S. I 4,[5],12:i:-, S. Infantis, S. Montevideo, S. Braenderup, S. Thompson, S. Saintpaul, S. Heidelberg, S. Oranienburg, S. Bareilly, S. Berta, S. Agona, and S. Anatum, which were responsible for 53.7% Salmonella infections in the U.S. in 2016. This cost-effective and rapid method can be utilized as an on-site colorimetric method for Salmonella detection.

Chest wall abscess and costochondritis due to Salmonella enterica serotype Choleraesuis: a case report.

BACKGROUND: Salmonella enterica serotype Choleraesuis infections usually cause self-limited gastrointestinal diseases. Extra-abdominal infections are often secondary to bacteremia in immunocompromised individuals and are relatively rare in immunocompetent hosts. CASE PRESENTATION: A 65-year-old Caucasian female initially presented to the thoracic surgery clinic due to a poorly healing wound on her chest. Her condition started after a mechanical fall hitting her chest with interval development of a tender lump that later spontaneously drained. A chest computed tomography scan with intravenous contrast demonstrated an abnormal infiltration with small foci of fluid and air consistent with a small abscess anterior to the left seventh costal cartilage. Aspirate culture of the abscess grew S. enterica serotype Choleraesuis susceptible to ampicillin and trimethoprim/sulfamethoxazole. The patient had no prior history of signs or symptoms of gastrointestinal infection. Blood cultures were negative. With a background of penicillin allergy, she was treated with trimethoprim/sulfamethoxazole, and later with ceftriaxone due to persistent drainage of the wound. Follow-up chest computed tomography scan with intravenous (IV) contrast showed continued abnormal findings previously seen in the computed tomography scan with the appearance of a sinus tract. The patient subsequently underwent surgical debridement and partial resection of the left seventh costochondral cartilage and excision of the fistula. She had an uneventful recovery and complete resolution of her condition. CONCLUSION: We report a rare case of chest wall abscess with associated costochondritis due to S. enterica serotype Choleraesuis in a patient with no evidence of immunodeficiency nor history of bacteremia. Extraintestinal infections due to Salmonella without documented bacteremia have been previously reported in the literature. History of local trauma to the affected area might contribute to the seeding of infection. Diagnosis is often accomplished by clinical evaluation and culture of the affected area. Treatment often involves targeted antibiotic therapy but may require surgical intervention to achieve source control and cure.

Typhoid spondylodiscitis of the cervical spine.

Spinal infection comprises pyogenic and non-pyogenic spondylodiscitis. This condition may manifest with non-specific clinical symptoms, elevated infective parameters and imaging findings that are difficult to distinguish. The cornerstone of a definitive diagnosis and subsequent successful treatment lies in tissue analysis through culture and histopathological studies. In this context, we present a case of Salmonella pyogenic spondylodiscitis affecting the C5/C6 vertebrae, complicated by Salmonella bacteraemia and characterised by mechanical neck pain that curtails daily activities and overall functioning, although without neurological deficits. The uniqueness of this case stems from its occurrence in an immunocompetent individual from a non-endemic area, with no identifiable sources of Salmonella infection or preceding gastrointestinal symptoms.

Epidemiology of Nontyphoidal Salmonella Bloodstream Infections in Children.

BACKGROUND: Nontyphoidal Salmonella (NTS) infections are the most common culture-confirmed foodborne illness in the United States. Although extremes of age and chronic or immunosuppressing conditions are known risk factors for NTS bloodstream infection (BSI), further predictors of BSI and BSI with focal infection in children remain poorly understood. METHODS: This was a retrospective review of NTS-positive blood cultures collected from 1999 to 2018 and stool studies collected from 2009 to 2018 in children. Incidence rates and risk factors for NTS BSI with and without focal infection were determined. RESULTS: Incidence rates of NTS BSI have not decreased over the last 20 years. There were 211 cases of NTS BSI with an incidence rate of 1.4 per 100 000 children per year. Twenty-one (10%) had underlying comorbidities. S. heidelberg was the most common serotype occurring in 45 (21%) cases. Compared with children with uncomplicated NTS BSI, children with NTS BSI with focal infection were more likely to have an underlying comorbidity, less diarrhea, and higher absolute neutrophil count. On multivariable analysis, the only difference in having NTS BSI in children with NTS gastroenteritis who had blood cultures obtained was a longer duration of fever (4.4 vs 2.5 days), less bloody diarrhea, and S. heidelberg isolated from stool. Laboratory studies, group of NTS, and other symptoms were not significant. CONCLUSIONS: Clinicians should remain vigilant for NTS BSI in children with prolonged fevers. S. heidelberg is the most common cause of NTS BSI in children and a predictor of BSI in children with NTS gastroenteritis.

Salmonella meningitis in a young child from Pakistan: a case report.

BACKGROUND: Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting infants, children, and immunocompromised individuals. CASE PRESENTATION: We present a case of a two-and-a-half-year-old Asian boy who developed Salmonella meningitis along with pneumonia and respiratory failure. Initially, he experienced symptoms of loose motions, fever, and irritability, which progressed to neck stiffness and brisk reflexes. Cerebrospinal fluid (CSF) analysis confirmed Salmonella typhi in the CSF. Due to the worsening condition, the patient was admitted to the intensive care unit, intubated, and switched to meropenem as the antibiotic of choice after an initial empiric therapy with ceftriaxone and vancomycin. With appropriate treatment, the patient showed significant improvement, including resolution of fever and respiratory symptoms. CONCLUSION: Management of Salmonella meningitis is often challenging primarily because of the fact that the empiric therapy for meningitis may not always provide coverage to the multi-drug resistant Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on sensitivity testing is crucial for successful management. This case emphasizes the importance of early recognition and effective management of this uncommon yet severe complication of Salmonella infection.

Case of non-typhoidal Salmonella spp mycotic popliteal artery aneurysm with concurrent deep vein thrombosis.

Mycotic aneurysms are a well-recognised complication of non-typhoidal Salmonella bacteraemia; the risk is increased in patients with atherosclerotic disease. The infrarenal abdominal aorta is the most common site of infection; lower extremity aneurysms are uncommon.1Here we present the case of a patient with cardiovascular disease and recurrent non-typhoidal Salmonella bacteraemia, who developed a left-sided popliteal artery mycotic aneurysm with secondary popliteal vein thrombosis. The aneurysm was diagnosed upon rupture, and managed with surgical excision and bypass graft. He went on to have a complete recovery.This case illustrates the importance of clinician awareness of popliteal artery endovascular infection as a rare but significant complication of non-typhoidal Salmonella bacteraemia, which should be considered in cases with cardiovascular risk factors, recurrent or persistent bacteraemia, and lower limb deep vein thrombosis.

A Pilot Study to Detect Viable Salmonella spp. in Diarrheal Stool Using Viability Real-Time PCR as a Culture-Independent Diagnostic Tool in a Clinical Setting.

Frontline laboratories are adopting culture-independent diagnostic testing (CIDT) such as nucleic acid amplification tests (NAATs) due to numerous advantages over culture-based testing methods. Paradoxically, the viability of pathogens, a crucial factor determining active infections, cannot be confirmed with current NAATs alone. A recent development of viability PCR (vPCR) was introduced to mitigate this limitation associated with real-time PCR (qPCR) by using a DNA-intercalating dye to remove residual and dead cell DNA. This study assessed the applicability of the vPCR assay on diarrheal stools. Eighty-five diarrheal stools confirmed for Salmonellosis were tested via qPCR and vPCR using in-house primers and probe targeting the invA gene. vPCR-negative stools (Ct cut off > 31) were enriched in mannitol selenite broth (MSB) to verify low bacterial loads. vPCR assay showed ~89% sensitivity (qPCR- and vPCR-positive stools: 76/85). vPCR-negative stools (9/85; qPCR-positive: 5; qPCR-negative: 4) were qPCR- and culture-positive post-MSB-enrichment and confirmed the presence of low viable bacterial loads. Random sampling error, low bacterial loads, and receiving stools in batches could contribute to false negatives. This is a pilot study and further investigations are warranted to explore vPCR to assess pathogen viability in a clinical setting, especially when culture-based testing is unavailable.

Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review.

Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.

Differentiation of Salmonella vaccinated and infected animals by serological detection of antibody to T3SS effector SsaK in an indirect ELISA.

The differentiation of animals that are vaccinated and those that are naturally infected with Salmonella is difficult by conventional serological tests. We have shown here an indirect Enzyme-linked immunosorbent assay for detection of Salmonella infection based on the presence of a Type III secretory effector SsaK in the sera.

Salmonella Durban meningitis: case report and genomics study.

BACKGROUND: Bacterial meningitis caused by non-typhoid Salmonella can be a fatal condition which is more common in low and middle-income countries. CASE PRESENTATION: We report the case of a Salmonella meningitis in a Belgian six-month old male infant. The first clinical examination was reassuring, but after a few hours, his general state deteriorated. A blood test and a lumbar puncture were therefore performed. The cerebrospinal fluid analysis was compatible with a bacterial meningitis which was later identified by the NRC (National Reference Center) as Salmonella enterica serovar Durban. CONCLUSIONS: In this paper, we present the clinical presentation, genomic typing, and probable sources of infection for an unusually rare serovar of Salmonella. Through an extended genomic analysis, we established its relationship to historical cases with links to Guinea.

Osteomyelitis in Sickle Cell Anemia: Does Age Predict Risk of Salmonella Infection?

BACKGROUND: Osteomyelitis is a condition that disproportionately affects those with sickle cell anemia (SCA). Despite the frequency of osteomyelitis in this population, there are reports of increasing life expectancy and rates of Staphylococcus aureus infections, which contrasts the belief that Salmonella is the most common organism identified. The purpose of this systematic review is to determine the most commonly identified organism and identify whether age is associated with the development of Salmonella osteomyelitis in homozygous sickle cell patients. METHODS: A search of PubMed, EMBASE Cochrane and databases was performed for studies of all levels of evidence pertaining to osteomyelitis in SCA. Reasons for exclusion included non-English language, case reports, literature reviews, isolated septic arthritis without bony involvement and isolated oral-facial bony involvement. RESULTS: The most common pathogen cultured was nontyphoid Salmonella , which occurred in 117 of 192 (60.9%) of cases identified. This was followed by S. aureus 41 of 192 (21.8%) and other enteric bacteria 14 of 192 (7.2%). Subgroup analysis demonstrated differences at the age of initial presentation with Salmonella cohort at 6.8 years and S. aureus cohort at 22.1 years ( P = 0.0001). On geographic analysis, African countries had an older average age of diagnosis at 13.1 years with decreased rates of Salmonella infections and increased rates of infections from other organisms compared with the US, Middle East and Europe. CONCLUSIONS: This systematic review suggests that Salmonella is most commonly identified in patients with SCA (HbSS phenotype) especially those <12 years old presenting with acute osteomyelitis. Sub-Saharan African countries had later ages of diagnosis compared with the US, Middle East and Europe with bacterial profiles that favors a diagnosis of chronic osteomyelitis and missed acute initial presentation. Therefore, age of presentation is likely a surrogate for geographic and socioeconomic factors such as availability of medical screening and treatment.

A rare case of Salmonella Paratyphi C osteomyelitis: A genetic analysis and review of Salmonella osteomyelitis in England.

Salmonella osteomyelitis is rare in patients without sickling hemoglobinopathies. Invasive disease caused by Salmonella Paratyphi C is rarer still with only one case reported in the United Kingdom in the last 15 years. We report a case of relapsing S. Paratyphi C osteomyelitis in a newly diagnosed diabetic patient from Ghana. Our patient was initially treated successfully with surgical debridement followed by 6 weeks of IV ceftriaxone before recrudescence 9 months later. Due to the rarity of S. Paratyphi C and the lack of recent travel, genomic analysis was undertaken to assess possible sources with the closest related strain being from Cote d'Ivoire. The patient had likley picked up the strain several years before presentation. We review current Salmonella osteomyelitis literature and audit all cases referred to the England and Wales Salmonella national reference laboratory over the last 15 years.