Related Experiment Videos
Extensively Drug-resistant Salmonella typhi Meningitis in a 16-year-old Male
Noman Khurshid1, Bilal Ahmed Khan2, Syed Wasif Bukhari1
1Miscellaneous, Dow Medical College, Dow University of Health Sciences, Karachi, PAK.
Abstract:
Meningitis caused by Salmonella enteritidis is an uncommon infection, linked with great mortality and neurological problems, which makes prompt diagnosis and treatment very crucial. Patients of bacterial meningitis present with common symptoms such as headache, fever, altered level of consciousness, and neck rigidity. A positive gram stain or culture of cerebrospinal fluid (CSF) leads to its diagnosis. In this report, we present a case of a 16-year-old male with extensively drug-resistant (XDR) Salmonella typhi meningitis, which was not responsive to initial medical intervention. He was treated with meropenem, imipenem, azithromycin, and metronidazole. Immediate tracheostomy and intubation were performed in the surgical intensive care unit (ICU), as the patient had developed stridor, shortness of breath, tachypnea, tachycardia, and had severely decreased O2 saturation of 60%. As far as treatment is concerned, third-generation cephalosporins are considered the treatment of choice. In addition, the use of fluoroquinolones and carbapenems, mainly meropenem, has also been described as a therapeutic alternative.
Insights
Extensively drug-resistant Salmonella typhi meningitis is rare and dangerous. This case highlights the critical need for prompt diagnosis and aggressive treatment in severe bacterial meningitis infections.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Bacterial meningitis, particularly Salmonella typhi meningitis, presents significant mortality and neurological risks.
- Early diagnosis and intervention are critical for managing this uncommon infection.
- Standard symptoms include fever, headache, neck rigidity, and altered consciousness.
Observation:
- A 16-year-old male presented with extensively drug-resistant (XDR) Salmonella typhi meningitis.
- Initial treatments were ineffective, necessitating aggressive interventions.
- The patient developed severe respiratory distress requiring tracheostomy and intubation.
Findings:
- Cerebrospinal fluid (CSF) gram stain and culture are key diagnostic tools.
- Treatment involved broad-spectrum antibiotics including carbapenems (meropenem, imipenem), azithromycin, and metronidazole.
- Third-generation cephalosporins are standard treatment, with fluoroquinolones and carbapenems as alternatives.
Implications:
- This case underscores the challenges in treating XDR bacterial meningitis.
- Prompt recognition and multidisciplinary critical care are vital for patient survival.
- Further research into effective treatments for resistant bacterial meningitis is warranted.