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Remote salmonellosis: surgical masquerader
Abstract:
The salmonella group of bacteria consists of at least 1700 subtypes and causes widespread gastroenteric disease throughout the world, there being approximately two million cases yearly in the United States alone. An uncommon but interesting complication is the hematogenous lodgment of organisms in other sites of the body with resultant localized abscess formation, often months or years later. We present a review of 15 cases seen in our affiliated hospitals over a nine-year period. Remote salmonellosis most often occurs in patients with underlying systemic disease, such as lupus, malignancy, diabetes, and sickle cell disease, or in association with therapy that suppresses host resistance including steroids and cancer chemotherapy. The most frequent sites of involvement are bone marrow, joints, meninges, pleura, and blood vessels, or in an area of locus minoris resistentiae. The latter include scars, hematomas, fracture sites, prosthetic devices, and neoplasms. Our experience would suggest that these infections, which can remote both in location and time from the original gastrointestinal episode, are perhaps more frequent today than is generally realized. Diagnosis is often delayed because of lack of familiarity with this entity. Treatment consist of either drainage or excision of infected tissue often combined with long-term antibiotics.
Insights
Salmonella infections can spread to distant body sites, causing abscesses months or years later, especially in immunocompromised individuals. Early diagnosis and treatment are crucial for managing these rare but serious Salmonella complications.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Salmonella bacteria cause millions of gastroenteric illnesses globally each year.
- A rare complication involves hematogenous spread leading to localized abscesses distant from the initial infection site.
- This review examines 15 cases of remote salmonellosis over nine years.
Observation:
- Remote salmonellosis frequently affects patients with systemic diseases (lupus, diabetes, sickle cell) or those on immunosuppressive therapies (steroids, chemotherapy).
- Common sites of infection include bone marrow, joints, meninges, pleura, blood vessels, and areas of prior injury or implants (locus minoris resistentiae).
- These remote infections can occur significantly later than the primary gastrointestinal episode.
Findings:
- The study suggests remote salmonellosis may be more common than generally recognized.
- Delayed diagnosis is often attributed to unfamiliarity with this clinical presentation.
- Treatment involves surgical intervention (drainage/excision) and prolonged antibiotic therapy.
Implications:
- Increased awareness among clinicians is needed to facilitate earlier diagnosis and improve patient outcomes.
- Understanding risk factors can help identify patients susceptible to developing remote Salmonella infections.
- Effective management strategies combining surgical and antimicrobial approaches are essential for treating these complex infections.