Salmonella infections of the mitral valve and abdominal aorta

Endocarditis and mycotic aneurysm of the great blood vessels are two serious complications of non-typhoidal salmonella gastroenteritis. Two patients are presented, the first with endocarditis due to S. dublin cured by combined treatment with ampicillin and gentamicin, the second with a fatal aneurysm of the aorta caused by Salmonella infantis. Salmonella endocarditis, particularly with left-sided cardiac involvement, has an especially poor prognosis. Survival is rare without surgery. Chemotherapy should consist of a synergistic combination such as ampicillin with an aminoglycoside for a period of 4-6 weeks. Mycotic aneurysm generally results from haematogenous infection of a previously damaged arteriosclerotic vessel. Salmonella spp. cause approximately 20% of all mycotic aneurysms and there is some evidence to suggest that their role is increasing. Repeatedly positive blood cultures in spite of antimicrobial treatment in an elderly patient should raise the suspicion of an endovascular localisation of the infection. Rapid surgical intervention and appropriate chemotherapy are needed before rupture takes place.