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Common bile duct stones: a cause of chronic salmonellosis
1Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
Abstract:
A chronic carrier state of Salmonella spp is present in 0.15% of the population, and is believed to be related to the presence of a diseased gallbladder. We present a patient with common bile duct (CBD) stones, whose bile cultures repeatedly indicated Salmonella typhi, despite an adequate course of antibiotic treatment. The carrier state was abolished after removal of the CBD stones 4 months later. The chronic carrier state may be related to biofilm formation on the surface of the CBD stones. The removal of the biliary stones, which are the most likely reservoir for Salmonella spp, may be a crucial step in eradication of the carrier state.
Insights
A chronic Salmonella typhi carrier state in a patient with common bile duct stones was resolved after surgical stone removal. This suggests biliary stones may harbor Salmonella, and their removal is key to eradicating the carrier state.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- A chronic carrier state for Salmonella species (spp.) affects 0.15% of the population, often linked to gallbladder disease.
- Salmonella typhi is a significant human pathogen, causing typhoid fever and prolonged carrier states.
Observation:
- A patient presented with common bile duct (CBD) stones and persistent Salmonella typhi bacteremia, unresponsive to antibiotics.
- The carrier state persisted despite appropriate antibiotic therapy, indicating a potential reservoir for the bacteria.
Findings:
- Bile cultures remained positive for Salmonella typhi until the common bile duct stones were surgically removed.
- Following stone removal, the patient's carrier state was successfully eradicated, with negative bile cultures.
- Biofilm formation on the surface of the CBD stones is hypothesized as the mechanism for harboring Salmonella spp.
Implications:
- Common bile duct stones may serve as a critical reservoir for Salmonella spp. in chronic carriers.
- Surgical removal of biliary stones could be an essential strategy for eradicating chronic Salmonella carrier states.
- This case highlights the importance of considering biliary tract pathology in persistent Salmonella infections.