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Relapsing Salmonella Meningitis in an Infant: A Case Report and Review of the Literature

Sonia Alexiadou1, Elpis Mantadakis1,2, Ioanna Irakleidou3

  • 1Department of Pediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece.

Case Reports in Pediatrics
|August 18, 2026
PubMed

Insights

Salmonella meningitis in infants can be missed by standard PCR tests. Prompt diagnosis and prolonged antibiotic treatment are crucial for recovery and preventing relapse.

Area of Science:

  • Pediatric Infectious Diseases
  • Bacterial Pathogenesis
  • Clinical Microbiology

Background:

  • Accurate diagnosis of bacterial meningitis in young febrile infants is critical for timely and appropriate treatment.
  • Commercially available multiplex PCR assays offer rapid pathogen detection but often exclude *Salmonella* spp. and other Enterobacteriaceae.
  • Exclusion of key pathogens like *Salmonella* from diagnostic panels can lead to missed diagnoses and suboptimal treatment.

Purpose of the Study:

  • To report a case of *Salmonella enteritidis* meningitis and concurrent bacteremia in a 2-month-old infant.
  • To highlight the diagnostic challenges posed by *Salmonella* meningitis when relying on molecular assays.
  • To emphasize the importance of prolonged antimicrobial therapy for successful treatment and prevention of relapse.

Main Methods:

  • Case report detailing the clinical presentation, diagnostic workup, and treatment of an infant with *Salmonella enteritidis* meningitis.
  • Cerebrospinal fluid (CSF) and blood cultures were utilized for pathogen identification.
  • Multiplex PCR (FilmArray ME Panel) was performed on CSF, alongside CSF analysis (cytology and biochemistry).

Main Results:

  • The infant presented with symptoms suggestive of bacterial meningitis; however, CSF culture and multiplex PCR were negative due to prior antibiotic exposure.
  • *Salmonella enteritidis* was isolated from blood cultures, leading to a diagnosis of meningitis and bacteremia.
  • The patient experienced a relapse of meningitis and bacteremia after initial treatment, necessitating prolonged combination antimicrobial therapy.

Conclusions:

  • *Salmonella* meningitis is a rare but severe infant infection that may be overlooked by current molecular diagnostic panels.
  • Negative CSF PCR results in infants with clinical signs of meningitis warrant cautious interpretation and consideration of alternative pathogens.
  • Extended antimicrobial treatment (4-6 weeks) is essential for managing *Salmonella* meningitis to prevent relapse and ensure favorable outcomes.

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