Invasive non-typhoidal Salmonella infection complicated by metastatic infections: Report of three cases
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Published on: September 22, 2019
Mariana Dumitru Taliha1, Eric Balti2, Evelyne Maillart3
1Department of Internal Medicine, Division of Geriatric Medicine, Brugmann University Hospital, Brussels, Belgium.
Abstract:
Non-typhoidal Salmonella (NTS) disease is usually a self-limiting infection presenting with digestive symptoms. However, disseminated presentation with involvement of secondary infectious sites is observed. We report diagnostic specificities and challenges related to the management of three patients with invasive NTS (iNTS) and secondary infectious locations. Among the seven patients (age range 46 - 83 years), four (two with extra-digestive infectious sites) had at least one immune debilitating condition. Two patients were incidentally discovered with iNTS and deceased after developing a septic shock despite antimicrobial treatment. Two individuals recovered under medical treatment without complications. Three other patients presented with secondary infectious sites. Case 1 suffered from urinary tract infection and dorsolumbar spondylodiscitis that responded well to antimicrobials and surgery. Abdominal prosthetic aortic aneurysm was diagnosed in case 2 and medical treatment only was applied. After four years of follow-up, he remains under antimicrobial treatment. Case 3 presented with conjoint thoracic aortic aneurysm and cutaneous abscesses managed with antimicrobials and surgery. Atherosclerosis and previous vascular intervention were the predisposing events for vascular involvement. iNTS is a serious disease carrying a high risk of mortality or secondary locations. Secondary locations can be managed by long duration antimicrobial therapy combined with surgery. Spine and aortitis are the most frequent secondary locations. Multi-drug resistant NTS represent an additional risk of mortality. Public health measures should be implemented to limit the spread of NTS to humans and the emergence of drug resistance.
Insights
Non-typhoidal Salmonella (NTS) infections can become invasive, leading to secondary sites and high mortality. Early diagnosis and combined antimicrobial and surgical treatments improve outcomes for invasive NTS (iNTS) with secondary locations.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Non-typhoidal Salmonella (NTS) typically causes self-limiting gastrointestinal illness.
- Disseminated invasive NTS (iNTS) disease can lead to secondary infectious sites and increased mortality.
- Risk factors include advanced age and immunocompromising conditions.
Observation:
- Seven patients with iNTS were analyzed, with ages ranging from 46 to 83 years.
- Four patients had predisposing immune-debilitating conditions.
- Two patients died from septic shock, two recovered fully, and three developed secondary infections.
Findings:
- Secondary infectious sites included urinary tract infections, spondylodiscitis, and aortic aneurysms (abdominal and thoracic).
- Vascular involvement was linked to atherosclerosis and prior interventions.
- Spine and aortitis were the most common secondary locations.
- Multi-drug resistant NTS increased mortality risk.
Implications:
- Invasive NTS is a serious condition with significant mortality and morbidity risks.
- Long-term antimicrobial therapy combined with surgical intervention is effective for managing secondary iNTS locations.
- Public health strategies are crucial to limit NTS spread and combat antimicrobial resistance.
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