Salmonella typhi Meningitis in an Immunocompetent Asian Adult

Enteric salmonella infections are common in the United States though nonenteric salmonella infections in immunocompetent adults are exceedingly rare in the United States, and meningitis is one of the least common extra-intestinal sites. In addition, it is very unusual for a patient with bacterial meningitis to present with meningitis signs and symptoms of >72 h duration like aseptic meningitis.  A 25-year-old Indian male, without any past medical history brought by friends to the ER had fever and irritability for a week. He became increasingly somnolent and confused three days back. Physical exam reveals signs of meningitis and laboratory showed cerebrospinal fluid (CSF) studies suggestive of bacterial meningitis. Culture of CSF grew Salmonella typhi and later on blood culture also grew S. typhi. The patient became worse with cerebral edema and hydrocephalous suspected by change in neurological status and confirmed by ultrasound of eye ball examining optic nerve sheath diameter and CT scan of brain. The patient required neurosurgical intervention and hence external ventricular drain was placed. The patient was also placed on mechanical ventilation. Subsequently he developed ventilator associated pneumonia (VAP) with carbapenem-resistant Pseudomonas aeruginosa. The patient underwent tracheostomy and successfully completed treatment of VAP and was transferred to his home country after four months. Thus we describe a rare case of salmonella meningitis in an immunocompetent adult.