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Septic Arthritis due to Salmonella Paratyphi A in a Splenectomized Thalassemia Patient
Sadia Khan1, Sahil Gaba2, Rohit Garg3
1Professor & Head, Department of Microbiology, Amrita School of Medicine, Faridabad, Haryana, India, Corresponding Author, Orcid: https://orcid.org/0000-0002-9361-4663.
Abstract:
Salmonella bone and joint infections are unusual and account for <1% of cases of septic arthritis and osteomyelitis. We report the case of a patient with monoarticular septic arthritis with underlying beta thalassemia who had undergone splenectomy 17 years earlier. Ultrasound-guided aspiration of pus from the affected hip joint grew Salmonella Paratyphi A. The patient was started on sensitive antibiotics and responded well to treatment. Salmonella septic arthritis is more commonly observed in individuals with comorbid conditions, such as hemoglobinopathies (particularly sickle cell anemia), pre-existing joint disorders such as rheumatoid arthritis, hematologic malignancies, systemic lupus erythematosus (SLE), or other conditions associated with increased hemolysis. A limited number of cases of Salmonella septic arthritis have been reported in thalassemia patients. In typhoid endemic regions of the world, culture and susceptibility of joint fluids from septic arthritis cases can guide physicians in appropriate and timely diagnosis of this entity, especially in patients who are immunosuppressed.
Insights
Salmonella Paratyphi A caused a rare hip joint infection in a patient with beta thalassemia. Prompt antibiotic treatment led to a successful recovery, highlighting the importance of joint fluid cultures in endemic areas.
Area of Science:
- Infectious Diseases
- Rheumatology
- Hematology
Background:
- Salmonella bone and joint infections are rare, comprising less than 1% of septic arthritis and osteomyelitis cases.
- Patients with comorbid conditions like hemoglobinopathies, rheumatoid arthritis, hematologic malignancies, or systemic lupus erythematosus are more susceptible to Salmonella septic arthritis.
- Thalassemia patients, particularly those who have undergone splenectomy, represent a vulnerable group for invasive Salmonella infections.
Purpose of the Study:
- To report a case of Salmonella Paratyphi A septic arthritis in a patient with beta thalassemia and a history of splenectomy.
- To emphasize the importance of considering Salmonella in the differential diagnosis of septic arthritis, especially in endemic regions and in immunocompromised individuals.
- To highlight the successful management and positive outcome with appropriate antibiotic therapy.
Main Methods:
- A case report detailing a patient with monoarticular septic arthritis.
- Ultrasound-guided aspiration of synovial fluid from the affected hip joint.
- Microbiological culture and antibiotic susceptibility testing of the joint fluid.
- Administration of sensitive antibiotics based on culture results.
Main Results:
- Salmonella Paratyphi A was identified as the causative agent in the hip joint fluid.
- The patient received appropriate antibiotic therapy and showed a favorable clinical response.
- The case underscores the unusual presentation of Salmonella septic arthritis in a thalassemia patient.
Conclusions:
- Salmonella septic arthritis, though uncommon, can occur in patients with underlying conditions like thalassemia and prior splenectomy.
- Early diagnosis through joint fluid culture and susceptibility testing is crucial for effective treatment, especially in typhoid-endemic areas.
- Prompt and targeted antibiotic therapy leads to good outcomes in Salmonella septic arthritis.
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