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Salmonella typhimurium-associated severe protracted diarrhea in infants and young children
V Khoshoo1, P Raj, R Srivastava
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Insights
Severe protracted diarrhea in infants caused by Salmonella typhimurium infection can lead to significant weight loss and malabsorption. Prompt antibiotic treatment showed rapid clinical improvement in most affected children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Protracted diarrhea in infants is a serious condition associated with significant morbidity.
- Salmonella typhimurium infection can cause severe gastrointestinal distress and malabsorption in young children.
- Identifying specific pathogens and understanding their impact is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of infants with protracted diarrhea and Salmonella typhimurium infection.
- To assess the effectiveness of antibiotic treatment in managing severe Salmonella typhimurium-associated diarrhea.
- To highlight the diagnostic markers and challenges in treating this condition.
Main Methods:
- Retrospective analysis of eleven infants (4-14 months) with protracted diarrhea (>21 days) and weight loss.
- Clinical assessment including purging rates, electrolyte levels, and malabsorption tests (D-xylose, fecal alpha 1-antitrypsin, oral fat tolerance).
- Microbiological identification of Salmonella typhimurium and assessment of antimicrobial resistance.
Main Results:
- All eleven patients had Salmonella typhimurium infection, significant weight loss (16-25%), and signs of malabsorption.
- Diarrhea was secretory in 8/11, with high fecal sodium levels.
- The organism exhibited multidrug resistance.
- Antibiotic therapy (amikacin and nalidixic acid/norfloxacin) led to rapid clinical improvement in most patients.
- Two of the youngest infants did not survive.
Conclusions:
- Salmonella typhimurium is an important cause of severe protracted diarrhea and malabsorption in infants.
- Appropriate antibiotic therapy can significantly benefit children with this condition.
- Early diagnosis and targeted treatment are critical for improving outcomes and reducing mortality.
Abstract:
Eleven (13.8%) children (4-14 months; mean of 7.8 +/- 3.6 months) presenting with protracted diarrhea (duration greater than 21 days) and weight loss had associated infection with Salmonella typhimurium. All had documented weight loss of 16-25% and progressive clinical deterioration. On admission, they had high purging rates (greater than 4 ml/kg/h), hyponatremia (5/11), mucosal injury, and malabsorption as measured by 1 h blood D-xylose, fecal alpha 1-antitrypsin, and oral fat tolerance test. Diarrhea was secretory in 8 of 11 and fecal sodium was high (54-142 mEq/L; mean of 102 +/- 27 mEq/L). The organism showed multiple drug resistance. All patients received antibiotics (amikacin and nalidixic acid/norfloxacin) for 10-14 days, which was followed by rapid improvement in clinical status and absorption studies. The two youngest patients died. Due to ethical reasons, an untreated control group was not included. Use of appropriate antibiotics may benefit children with S. typhimurium-associated severe protracted diarrhea and rapid progressive weight loss.