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Salmonella enteritidis. A rare cause of pyelonephritis in children
Insights
A rare case of Salmonella enteritis complicated by acute pyelonephritis in a young boy highlights the role of obstructive uropathy. Early diagnosis and treatment are crucial for managing this unusual Salmonella infection presentation.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Urology
Background:
- Acute pyelonephritis is a common kidney infection in children, typically caused by Escherichia coli.
- Salmonella enteritis is usually associated with gastrointestinal symptoms, with urinary tract involvement being rare.
Observation:
- A previously healthy 2.5-year-old boy presented with acute pyelonephritis following acute gastroenteritis.
- Cultures revealed Salmonella enteritidis sensitive to ampicillin, treated successfully with parenteral and oral antibiotics.
- Renal ultrasonography identified left hydronephrosis and megaureter, indicating ureterovesicular junction obstruction.
Findings:
- Salmonella enteritidis can cause acute pyelonephritis in children, although this is infrequently documented.
- Obstructive uropathy, specifically a ureterovesicular junction obstruction, was identified as a likely predisposing factor for the pyelonephritis.
- Surgical repair of the obstruction was performed following diagnosis.
Implications:
- This case underscores the importance of considering Salmonella as a potential pathogen in pediatric pyelonephritis, especially in the presence of gastrointestinal illness.
- Underlying urinary tract abnormalities, such as obstructive uropathy, may predispose children to unusual complications of Salmonella infections.
- Prompt diagnosis and management of both infection and anatomical obstruction are critical for favorable outcomes in pediatric patients.
Abstract:
A previously healthy 2.5-year-old boy developed symptoms of acute pyelonephritis following an acute gastroenteritis. The patient received parenteral ampicillin and gentamicin for 72 hours and then ampicillin for an additional 11 days when the original urine and stool cultures grew Salmonella enteritidis, sensitive to ampicillin. The patient responded very well to treatment, but B-mode renal ultrasonogram revealed a left hydronephrosis and megaureter suggestive of longstanding obstruction of the ureterovesicular junction, later confirmed by other diagnostic studies and by surgical exploration and repair. Salmonella infection has been rarely documented to cause pyelonephritis in children. Obstructive uropathy appears to be a predisposing factor for this unusual complication of Salmonella enteritis.