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CASE IMAGE
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 56-57

Salmonella, an uncommon cause of multiple brain abscesses in an infant


Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission22-Jan-2022
Date of Decision24-Jan-2022
Date of Acceptance26-Jan-2022
Date of Web Publication25-Feb-2022

Correspondence Address:
Dr. Bobbity Deepthi
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_22_22

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How to cite this article:
Sugumar K, Deepthi B. Salmonella, an uncommon cause of multiple brain abscesses in an infant. Indian Pediatr Case Rep 2022;2:56-7

How to cite this URL:
Sugumar K, Deepthi B. Salmonella, an uncommon cause of multiple brain abscesses in an infant. Indian Pediatr Case Rep [serial online] 2022 [cited 2022 May 27];2:56-7. Available from: http://www.ipcares.org/text.asp?2022/2/1/56/338480

A 4-month-old boy was brought to the hospital actively seizing. He was euglycemic. Postseizure control, he was intubated for altered sensorium and poor respiratory efforts. Circulation was maintained. The infant was febrile, and history revealed high-grade, fever for a week, followed by multiple seizures for 3 days (brief up rolling of eyeballs) without loss of consciousness in between. There was no preceding trauma, ear discharge, and respiratory, gastrointestinal, or urinary symptoms. The infant was the first issue of non-related parents, born at term with normal birth weight. There was no significant past, antenatal, perinatal, or family history. The child was breast fed for the initial 3 months. Currently, he was being bottle-fed with diluted cow's milk. He was immunized and development was age appropriate.

His anthropometric measurements were normal. Cranium, sutures, fontanelle, and spine were unremarkable. Neurocutaneous markers and dysmorphic features were absent. The only salient examination findings was firm hepatosplenomegaly (liver span 6.5 cm and spleen 2 cm below costal margin). No cranial/focal neurological deficits or tone abnormalities were identified. The clinical diagnosis was acute febrile encephalopathy. Blood counts revealed hemoglobin 10.3 g/dL, white blood count 24 × 103/μL (80% neutrophils and 20% lymphocytes), and platelet count 330 × 103/μL. Serum electrolytes were normal. Cerebrospinal fluid (CSF) was grossly turbid with 200 leukocytes/mm3 (all neutrophils), hypoglycorrhachia (CSF glucose 35 mg/dL, blood glucose 118 mg/dL), and elevated protein (200 mg/dL). Blood and CSF cultures grew Salmonella enterica subspecies enteritidis, sensitive to ciprofloxacin and ceftriaxone. Despite antibiotics and multiple antiepileptics, seizures persisted, and he developed signs of increased intracranial pressure. Plain and contrast-enhanced computed tomography showed multiple brain abscess [Figure 1]. Intravenous antibiotics continued for 6 weeks. There was no indication for surgical intervention: fever abated; seizures ceased; sensorium improved; he was extubated, discharged, and kept under follow-up. Primary and secondary immunodeficiencies were excluded. After 6 months, serial head circumference monitoring demonstrates normal growth trajectory, whereas hearing assessment and neurodevelopmental status are normal.
Figure 1: (a) Non-contrast computed tomography (CT) brain demonstrating dilated ventricular system, and extra-axial subdural effusion bilateral (arrow); (b) Contrast-enhanced CT brain showing multiple peripherally enhancing lesions with surrounding edema (arrows) in periventricular brain parenchyma and basal ganglia

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Salmonella neuroinfection is uncommon in infants. This includes meningitis, subdural/epidural empyema, ventriculitis, venous infarcts, cerebritis,[1],[2],[3] and intracranial abscesses (100 case reports found). The clinical presentation of abscesses comprises of fever (~100%), seizures (75%), altered sensorium (60%), and focal deficits (40%).[2] High-risk factors include immunodeficiency states, asymptomatic carrier caregivers, and contaminated feeds. Diagnosis is established by the clinical phenotype, neuroimaging, and cultures. The primary management is prolonged antibiotic therapy. The surgical intervention including drainage of abscess and/or subdural effusion, or placement of ventriculoperitoneal shunt, is individualized. Salmonella meningitis has high likelihood of morbidity, acute complications, and neurological sequelae (epilepsy, visual/hearing impairment, locomotor disability, etc.).[3] Early recognition is associated with better prognosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parents have given their consent for patient's images and other clinical information to be reported in the journal. The patient's parents understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We thank Dr. S. Krishnamurthy, A.C. Chidambaram, and Dr. N. Shanmugasundaram for assistance in patient management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Blázquez D, Muñoz M, Gil C, et al. Brain abscess and epidural empyema caused by Salmonella enteritidis in a child: Successful treatment with ciprofloxacin: A case report. Cases J 2009;2:7131.  Back to cited text no. 1
    
2.
Williams V, Lakshmikantha KM, Nallasamy K, et al. Subdural empyema due to Salmonella paratyphi B in an infant: A case report and review of literature. Childs Nerv Syst 2018;34:2317-20.  Back to cited text no. 2
    
3.
Wu HM, Huang WY, Lee ML, et al. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan. BMC Infect Dis 2011;11:30.  Back to cited text no. 3
    


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