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Published on: November 7, 2018
Myositis associated with Salmonella paratyphi A bacteremia appears to be common
Adline Harris1, Stalin Viswanathan1, Rajeswari Aghoram2
1Department of General Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India.
Background:
Fever and severe myalgia in a tropical country like India bring to mind leptospirosis, rickettsioses, dengue, and other viral fevers. Enteric fever is widely prevalent in Asia, but myositis has not been previously described in Salmonella paratyphi A bacteremia.
Materials And Methods:
Retrospectively, we recruited patients with enteric fever admitted to our treating unit over a 6-month period. Demography, historical, clinical, and laboratory data were obtained. Data of culture-positive S. paratyphi A patients were analyzed and were compared with those patients with culture-negative enteric fever.
Results:
Forty-three cases were found in total with 19 of S. paratyphi A bacteremia. Elevations in creatine kinase (CK) ranged from one-and-half to six times normal. Forty-seven percent had thrombocytopenia and alanine transaminase elevations, while aspartate transaminase elevations were seen in 17 patients, which corresponded to those with elevated CK levels.
Conclusions:
Myositis associated with S. typhi and S. paratyphi is very rare and is more often due to non-typhoidal Salmonellae. Elevated creatine kinase was seen in most of our patients with S. paratyphi A bacteremia. Such myositis has not been described previously and hence, myalgia with fever in a tropical country could be a harbinger of paratyphoid fever.
Insights
Severe muscle pain and fever in tropical regions may indicate paratyphoid fever. This study describes a rare case of myositis associated with Salmonella paratyphi A bacteremia, highlighting elevated creatine kinase levels.
Area of Science:
- Infectious Diseases
- Tropical Medicine
- Microbiology
Background:
- Fever and severe myalgia in tropical countries often suggest infections like leptospirosis, rickettsioses, dengue, and other viral fevers.
- Enteric fever is common in Asia, but myositis has not been previously documented in Salmonella paratyphi A bacteremia.
Purpose of the Study:
- To investigate the occurrence and characteristics of myositis in patients with enteric fever, specifically Salmonella paratyphi A bacteremia.
Main Methods:
- A retrospective analysis of patients with enteric fever admitted over a 6-month period.
- Collection and analysis of demographic, clinical, and laboratory data.
- Comparison of culture-positive S. paratyphi A cases with culture-negative enteric fever cases.
Main Results:
- Out of 43 enteric fever cases, 19 had S. paratyphi A bacteremia.
- Elevated creatine kinase (CK) levels, ranging from 1.5 to 6 times normal, were observed.
- Associated findings included thrombocytopenia and elevated liver enzymes (ALT and AST) in a significant proportion of patients.
Conclusions:
- Myositis linked to Salmonella typhi and Salmonella paratyphi is uncommon, with non-typhoidal Salmonellae being more frequent causes.
- Elevated creatine kinase was a common finding in S. paratyphi A bacteremia patients with myositis.
- This previously undescribed association suggests that myalgia with fever in tropical regions could be an early sign of paratyphoid fever.
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