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[Endarterial infections, redoubtable complications of non-typhi salmonella infections]
Abstract:
Three cases are reported of salmonella aortitis observed in three men aged 55, 60 and 48 years, the last of whom had a prosthetic aortic valve and ascending aorta. The microorganisms were S. typhi murium, S. paratyphi B, and S. wien. Despite antibiotic treatment two patients died of perforating aortitis. The third patient developed S. wien gastroenteritis a few days after surgical replacement of the aortic valve and the ascending aorta. Five years later he presented with several bacteremic episodes due to S. wien, which recurred despite several courses of cotrimoxazole treatment. He has now been asymptomatic for over one year under prolonged cotrimoxazole treatment. Since vascular infection may occur following non typhi salmonellosis in 5% of patients over 50, or who have underlying endothelial lesions, the question arises as to whether non typhi S. gastroenteritis should be treated with antibiotics in these high risk patients, in contrast to present recommendations.
Insights
Salmonella aortitis is a rare but serious complication. This study highlights the risk of non-typhi Salmonella infections in patients with vascular conditions, suggesting a need for reconsidering antibiotic treatment guidelines.
Area of Science:
- Infectious Diseases
- Cardiovascular Medicine
- Microbiology
Background:
- Salmonella infections, particularly non-typhi serotypes, can lead to severe vascular complications.
- Aortitis, an inflammation of the aorta, poses a significant mortality risk.
- Patients with prosthetic valves or prior aortic surgery are potentially at higher risk.
Observation:
- Three cases of Salmonella aortitis in men aged 48-60 are presented.
- Infecting agents included Salmonella typhimurium, Salmonella paratyphi B, and Salmonella wien.
- Two patients with Salmonella aortitis died despite antibiotic therapy.
Findings:
- One patient with a prosthetic aortic valve developed Salmonella wien gastroenteritis post-surgery.
- This patient experienced recurrent Salmonella bacteremia over five years, requiring prolonged antibiotic treatment.
- Prolonged cotrimoxazole therapy ultimately led to a sustained asymptomatic period.
Implications:
- The study questions current recommendations regarding antibiotic treatment for non-typhi Salmonella gastroenteritis in high-risk individuals.
- Consideration should be given to antibiotic prophylaxis or early treatment in patients >50 years or with endothelial lesions.
- Early and prolonged antibiotic intervention may be crucial for preventing severe outcomes in susceptible populations.