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Salmonella meningitis and its complications in infants
W S Lee1, S D Puthucheary, A Omar
1Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Objective:
To review the presenting features, complications and outcome of infants with Salmonella meningitis.
Methodology:
Retrospective review of all cultures of cerebrospinal fluid positive for bacteria in children below 12 years of age, processed at the Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur from 1973 to 1997. Records of all cases positive for Salmonella species were retrieved and studied.
Results:
Thirteen infants aged 3 days to 9 months with Salmonella meningitis were included. The median age of onset of symptoms was 4 months. The clinical and laboratory features were similar to other causes of bacterial meningitis. Salmonella enteritidis was the commonest serotype isolated. Nine infants developed fits, six of which were difficult to control. Other complications noted were hydrocephalus (five), subdural effusions (four), empyema (three), ventriculitis (two), intracranial haemorrhage and cerebral abscess (one each). The use of ampicillin and/or chloramphenicol and inadequate duration of therapy resulted in recrudescence or relapse in five infants. The overall mortality was 18%. The presence of empyema, intracerebral abscess, ventriculitis, hydrocephalus, and intracranial haemorrhage were associated with adverse neurodevelopmental sequelae or death. More than half of those who survived had normal long-term outcome.
Conclusion:
Infants who developed neurological complications as a result of Salmonella meningitis had significant mortality and adverse long-term neurodevelopment outcome.
Insights
Salmonella meningitis in infants presents serious risks, with complications like seizures and hydrocephalus leading to significant mortality and long-term neurodevelopmental issues. Survivors often face adverse outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Salmonella meningitis is a severe infection in infants.
- Understanding its features, complications, and outcomes is crucial for management.
Purpose of the Study:
- To review the presenting features, complications, and outcomes of Salmonella meningitis in infants.
- To identify factors associated with mortality and long-term neurodevelopmental sequelae.
Main Methods:
- Retrospective review of cerebrospinal fluid cultures positive for Salmonella species in children under 12 years old (1973-1997).
- Analysis of clinical data, complications, treatment, and outcomes for 13 infants diagnosed with Salmonella meningitis.
Main Results:
- Thirteen infants (3 days to 9 months) had Salmonella meningitis, with Salmonella enteritidis being the most common serotype.
- Common complications included seizures, hydrocephalus, subdural effusions, empyema, ventriculitis, intracranial hemorrhage, and cerebral abscess.
- Mortality was 18%, and neurological complications were linked to adverse neurodevelopmental outcomes or death; over half of survivors had normal long-term outcomes.
Conclusions:
- Infants with Salmonella meningitis face a high risk of mortality and adverse neurodevelopmental outcomes, especially when neurological complications arise.
- Effective treatment and monitoring are essential to mitigate severe consequences.