A Case Report of Thrombocytopenia-associated Multiple Organ Failure Secondary to Salmonella enterica Serotype Typhi Infection in a Pediatric Patient: Successful Treatment With Plasma Exchange

A high proportion of the patients with Salmonella enterica serotype Typhi infection develop severe sepsis. The mortality rate is high despite aggressive antimicrobial therapy in these patients. The case of a 10-year-old boy who developed thrombocytopenia-associated multiple organ failure (TAMOF) secondary to S. typhi infection is reported. The patient did not respond to antimicrobial treatment, including ciprofloxacin, in addition to conventional supportive measures, so plasma exchange was performed. The thrombocytopenia and organ failure had resolved after 3 days of plasma exchange therapy. Plasma exchange is suggested to be a life-saving intervention in a child with TAMOF secondary to S. typhi infection.     

Systemic lupus erythematosus–associated catastrophic antiphospholipid syndrome occurring after typhoid fever: A possible role of Salmonella lipopolysaccharide in the occurrence of diffuse vasculopathy-coagulopathy

We report a case of well-documented typhoid fever in a 30-year-old woman with inactive systemic lupus erythematosus with asymptomatic lupus anticoagulant and high-titer anticardiolipin antibody (aCL). Despite prompt eradication of the Salmonella typhi obtained with appropriate antibiotic therapy, multiple organ system dysfunction occurred. The central nervous system was involved, with ischemic infarcts in the occipital lobes. High-dose corticosteroid therapy failed to improve the neurologic manifestations, which responded to repeated plasmapheresis. A sharp fall in aCL and anti–β₂-glycoprotein I antibody titers was recorded before the start of plasmapheresis. At the same time, IgM and IgG antibodies to Salmonella group O:9 lipopolysaccharide became detectable; the IgM antibodies disappeared within 4 months, whereas the IgG antibodies remained detectable during the next 13 months. Despite treatment with high-dose corticosteroids and cyclophosphamide, rapidly progressive glomerulonephritis developed, leading to chronic renal failure. There is convincing evidence of a link between the S typhi infection and the ensuing catastrophic syndrome in this patient, probably precipitated by bacterial antigens.     

Acute Transverse Myelitis Secondary to Salmonella paratyphi B Infection

Abstract Acute transverse myelitis (ATM) is a rare entity with an annual incidence of 4.6 per one million people. Its hallmark lesions are medullary perivenular inflammation and demyelination. The parainfectious form of ATM constitutes the most common subset of this entity. We report a woman with ATM secondary to Salmonella paratyphi B infection (paratyphoid fever) who was successfully treated with a specific parenteral antibiotic. Although, the association of Salmonella typhi infection and ATM is very rarely found in the literature, we believe this is the first report of ATM secondary to S. paratyphi B infection. Clinicians should consider ATM as a possible complication of infection with salmonella species.     

Typhoid fever

The host restricts dissemination of invasive enteric pathogens, such as non-typhoidal Salmonella serovars, by mounting acute inflammatory responses characterized by the recruitment of neutrophils. However, some enteric pathogens, such as Salmonella enterica serovar Typhi (S. typhi), can bypass these defenses and cause an invasive bloodstream infection known as typhoid fever. Recent studies on virulence mechanisms of S. typhi suggest that tight regulation of virulence gene expression during the transition from the intestinal lumen into the intestinal mucosa enables this pathogen to evade detection by the innate immune system, thereby penetrating defenses that prevent bacterial dissemination. This example illustrates how the outcome of host pathogen interaction at the intestinal mucosal interface can alter the clinical presentation and dictate the disease outcome.     

Clinical outcomes in typhoid fever: adverse impact of infection with nalidixic acid-resistant <Emphasis Type="Italic">Salmonella typhi</Emphasis>

Background  

Widespread use of fluoroquinolones has resulted in emergence of Salmonella typhi strains with decreased susceptibility to fluoroquinolones. These strains are identifiable by their nalidixic acid-resistance. We studied the impact of infection with nalidixic acid-resistant S. typhi (NARST) on clinical outcomes in patients with bacteriologically-confirmed typhoid fever.     

Acute liver failure as the initial manifestation of acute leukaemia

Abstract: Background/Aims: Haematological malignancies seldom cause clinically significant liver disease. Acute liver failure as the initial manifestation of acute leukaemia is very rare and carries a very poor prognosis. Methods/Results: Three cases of acute liver failure secondary to acute leukaemia are described. Each case presented initially as acute liver failure of uncertain cause. Specific treatment for the leukaemia was instituted; however, all three patients died as a consequence of the liver failure. We describe the clinical course and relevant investigations of these patients and discuss possible mechanisms of acute liver failure in this setting. Conclusion: Acute leukaemia presenting as acute liver failure has a very poor prognosis. Although a rare cause of acute liver failure, it should be considered in any patient presenting with acute liver failure with prodromal symptoms and a raised peripheral white cell count, lactate dehydrogenase and uric acid.     

Disseminated adiaspiromycosis: case report of a liver transplant patient with human immunodeficiency infection,and literature review

I. Pelegrín, J. Ayats, X. Xiol, M. Cuenca‐Estrella, A. Jucglà, S. Boluda, N. Fernàndez‐Sabé, A. Rafecas, F. Gudiol, C. Cabellos. Disseminated adiaspiromycosis: case report of a liver transplant patient with human immunodeficiency infection, and literature review.
Transpl Infect Dis 2011: 13: 507–514. All rights reserved Abstract: Disseminated adiaspiromycosis is a rare infection that is sometimes associated with immunocompromised situations. We report the case of a patient, infected with human immunodeficiency virus and receiving highly active antiretroviral therapy, who had a liver transplant for hepatocellular carcinoma. The patient presented skin and pulmonary lesions due to adiaspiromycosis during immunosuppressive therapy. A review of >60 cases in the literature shows that adiaspiromycosis is a rare infection and Emmonsia is a dimorphic fungus that is difficult to grow. It should be considered a possible diagnosis in case of fungal infection and pulmonary granulomatosis. We should be aware of emerging adiaspiromycosis in patients with risk factors of immunosuppression, particularly transplant recipients. In these patients in particular, liposomal amphotericin B therapy should be considered.     

Non-contiguous multifocal vertebral osteomyelitis caused by Serratia marcescens

Abstract

Serratia marcescens is a common nosocomial infection but a rare cause of osteomyelitis and more so of vertebral osteomyelitis. Vertebral osteomyelitis caused by this organism has been reported in few studies. We report a case of S. marcescens vertebral discitis and osteomyelitis affecting multiple non-contiguous vertebras. Although Staphylococcus aureus is the most common cause of vertebral osteomyelitis, rare causes, such as S. marcescens, need to be considered, especially when risk factors such as intravenous heroin use, post-spinal surgery and immunosuppression are present. Therefore, blood culture and where necessary biopsy of the infected region should be undertaken to establish the causative organism and determine appropriate antibiotic susceptibility. Prompt diagnosis of S. marcescens vertebral osteomyelitis followed by the appropriate treatment can achieve successful outcomes.     

Screening, phylogenetic analysis and antibiotic sensitivity pattern of Salmonella enterica serovar Typhi isolates from typhoid asymptomatic carriers

ObjectiveTo isolate the Salmonella enterica serovar Typhi (S. typhi) from asymptomatic typhoid carriers in the local population. To assess the antibiotic sensitivity and resistant pattern of S. typhi isolates against viable antibiotics and phylogenetic analysis of S. typhi isolates on the basis of 16S rDNA gene.MethodsS. typhi was isolated and identified based on the cultural characteristics on BSA (Bismuth Sulphite Agar), MacConkey agar, agglutination test with specific antiserum and phylogenetic analysis. S. typhi isolates were tested for sensitivity and resistant pattern with a number of viable antibiotics by disc diffusion method.ResultA total of 15 bile samples were collected from the food handlers to screen the typhoid asymptomatic carriers. Positive result was yielded for 3 out of 15 samples. S. typhi isolates showed resistant to amphicillin (100%), tetracyclin (100%), rifampicin (66.5%), ofloxacin (33.5%), cloxacillin (33.5%) and susceptibility to gentamycin (100%), amikacin (100%), chloramphenicol (100%), streptomycin (100%), kanamycin (100%), cprofloxacin (100%), amoxycillin (66.5%) and ofloxacin (66.5%).ConclusionsThis study demonstrates the outbreak of typhoid fever occurs through asymptomatic carrier. In addition, this study also reveals the occurrence of considerable drug resistant among the S. typhi isolates.     

Successful salvage therapy with daptomycin after linezolid and vancomycin failure in a liver transplant recipient with methicillin-resistant Staphylococcus aureus endocarditis

Abstract: Infective endocarditis is a rare complication affecting solid organ transplant recipients. Staphylococcus aureus is a common cause of infective endocarditis accounting for about 30% of cases. We present a case of nosocomial methicillin-resistant S. aureus endocarditis with persistent bacteremia, in a patient following orthotopic liver transplantation. We were unable to eradicate this infection with primary linezolid therapy or with secondary treatment with combined vancomycin and rifampicin, but successfully treated it with daptomycin, in addition to tricuspid and aortic valve replacement.     

Murine typhus in a liver transplant recipient: report of a first case

Zoonoses, especially rickettsial diseases, are rarely reported in solid organ transplant recipients. We report here a case of murine typhus in a 69‐year‐old liver transplant recipient, who presented with acute febrile illness 5 years post transplantation. Although receiving treatment with broad‐spectrum antibiotics, he was still febrile and developed progressive dyspnea. Laboratory results showed elevated transaminases and his chest radiograph revealed bilateral interstitial infiltration. The diagnosis of murine typhus was made by a 4‐fold rise in specific Rickettsia typhi antibody, using indirect immunofluorescent assay. He dramatically improved after treatment with doxycycline for 7 days. To our knowledge, this is the first case report of murine typhus in a liver transplant recipient.     

Pefloxacin versus chloramphenicol in the therapy of typhoid fever

Summary An open, randomized clinical study was carried out to compare the clinical efficacy and safety of pefloxacin with that of chloramphenicol in the treatment of typhoid fever. Sixty hospitalized patients (40 men and 20 women, aged from 17 to 64 years), affected by severe proven typhoid sepsis, were randomly assigned to treatment with pefloxacin at a daily dose of 1,200 mg for 15 days (Group A) or with chloramphenicol at a daily dose of 2 g for 15 days (Group B). The two groups of patients were statistically homogeneous regarding both age and sex and all patients were followed for 30 days after the end of therapy. In Group A all the patients completely recovered from infection and all the isolated strains ofSalmonella typhi were eradicated by pefloxacin treatment. In Group B two patients had a relapse, two patients became chronic enteric carriers ofS. typhi and only 26 patients recovered from infection with complete eradication of the pathogen. The results indicate that pefloxacin is as active as chloramphenicol in the therapy of typhoid fever and that pefloxacin could be a valid antibacterial agent to be used together with appropriate hygienic measures for an eradication program of typhoid fever in the endemic countries.

---

Pefloxacin im Vergleich zu Chloramphenicol bei Typhus

Zusammenfassung Zum Vergleich der klinischen Wirksamkeit und Sicherheit einer Behandlung mit Pefloxacin und Chloramphenicol in der Therapie des Typhus wurde eine offene, randomisierte klinische Studie durchgeführt. 60 hospitalisierte Patienten (40 Männer, 20 Frauen im Alter von 17 bis 64 Jahren) mit schwerem septischen Typhus erhielten nach Randomplan eine Behandlung mit Pefloxacin in einer Tagesdosis von 1.200 mg für 15 Tage (Gruppe A) oder mit Chloramphenicol in einer Tagesdosis von 2 g für 15 Tage (Gruppe B). Die beiden Patientengruppen waren hinsichtlich Alter und Geschlecht homogen, und alle Patienten wurden bis 30 Tage nach Therapieende nachkontrolliert. In der Gruppe A erholten sich alle Patienten vollständig von der Infektion. Alle isolierten Stämme vonSalmonella typhi waren nach Behandlung mit Pefloxacin eradiziert. In der Gruppe B traten bei zwei Patienten Rezidive auf, zwei Patienten wurden chronische Träger vonS. typhi und nur 26 Patienten waren nach der Erholung vollständig erregerfrei. Die Ergebnisse zeigten, daß Pefloxacin ebenso aktiv wie Chloramphenicol in der Behandlung des Typhus ist und ein wertvolles Antibiotikum darstellt, das zusammen mit Hygienemaßnahmen eingesetzt werden kann, um in den endemischen Ländern ein Eradikationsprogramm für Typhus durchzuführen.

     

Retrograde pyelonephritis and lumbar spondylitis as a result of Salmonella typhi in a type 2 diabetes patient with neurogenic bladder

We present a case of a 62‐year‐old diabetic woman with acute pyelonephritis and spondylitis caused by Salmonella typhi. She was admitted to Tokyo Medical Dental University Hospital, Tokyo, Japan, because of unconsciousness and was diagnosed with sepsis by retrograde pyelonephritis as a result of Salmonella typhi. Antibiotics treatment was immediately started; however, she subsequently developed lumbar spondylitis, and long‐term conservative treatment with antibiotics and a fixing device were required. This is the first report of a diabetic patient who developed retrograde urinary tract infection with Salmonella typhi, followed by sepsis and spondylitis. The infection could be a result of diabetic neuropathy, presenting neurogenic bladder and hydronephrosis. The patient was successfully treated with antibiotics and became asymptomatic with normal inflammatory marker levels, and no clinical sign of recurrence was observed in the kidney and spine at 4 months.     

Oral vaccination against enteric bacterial infections: An overview

Summary The present situation and the future prospects for the use of oral vaccines against the major enteric diseases typhoid fever, shigellosis and cholera are discussed in this paper. No significant protection could be demonstrated for oral inactivated whole-cell vaccines. In contrast, an oral live vaccine based on the attenuatedSalmonella typhi strain Ty 21a was highly efficacious in volunteer challenge studies and in a controlled field trial. Two attenuated strains are presently being tested in volunteer studies as candidate vaccines against shigellosis; one usesS. typhi Ty 21a and the otherEscherichia coli K-12 as the carrier for shigella antigens. Experimental challenge studies in volunteers showed that recovery from clinical cholera confers solid and long-lasting protection. The goal of present research is to develop a vaccine that mimics the events of clinical cholera without causing disease.

---

Orale Impfstoffe gegen enterale Bakterieninfektionen; eine Übersicht

Zusammenfassung Es werden die gegenwärtigen Möglichkeiten und Aussichten für die Verwendung oraler Impfstoffe gegen die wichtigsten enteralen Bakterieninfektionen Typhus, Dysenterie und Cholera besprochen. Orale Impfstoffe gegen Typhus, bestehend aus inaktivierten Bakterien, sind unwirksam. Demgegenüber erwies sich ein oraler Lebendimpfstoff, basierend auf dem attenuiertenSalmonella typhi Stamm Ty 21a, in klinischen Belastungsversuchen und in Feldversuchen als sehr wirksam. Gegenwärtig werden in Freiwilligen zwei attenuierte Stämme als mögliche Kandidaten für einen Lebendimpfstoff gegen Shigellose getestet; der eine benütztS. typhi Ty 21a und der andereEscherichia coli K-12 als Träger für Shigella Schutzantigene. Belastungsversuche in Freiwilligen haben gezeigt, daß eine überstandene Cholera-Erkrankung einen guten und langdauernden Schutz hinterläßt. Das Ziel gegenwärtiger Forschung ist, einen Impfstoff zu entwickeln, der möglichst nahe die Ereignisse einer Cholera-Infektion nachahmt, jedoch ohne deren Symptome auszulösen.

     

Aspergillus vertebral osteomyelitis and ureteral obstruction after liver transplantation

L.‐P. Zhu, X.‐S. Chen, J.‐Q. Wu, F.‐F. Yang, X.‐H. Weng. Aspergillus vertebral osteomyelitis and ureteral obstruction after liver transplantation.
Transpl Infect Dis 2011: 13 : 192–199. All rights reserved Abstract: Aspergillus osteomyelitis has been reported as a result of dissemination in solid organ transplant recipients. Vertebral osteomyelitis is one of the most common forms of Aspergillus osteomyelitis. An Aspergillus fungal ball is a rare cause of ureteral obstruction. We describe an unusual case of simultaneous vertebral osteomyelitis and ureteral obstruction caused by A. flavus in a hepatic transplant recipient, who was successfully treated with sequential intravenous and oral itraconazole solution.     

Imported Enteric Fever: Case Series from the Hospital for Tropical Diseases,London, United Kingdom

Our current knowledge of the clinical characteristics of enteric fever is drawn mainly from population-based studies in disease-endemic countries, and there are limited data published on cases in returning travelers. We report the clinical characteristics of enteric fever in 92 travelers returning to London, United Kingdom. Salmonella typhi and S. paratyphi resulted in an almost indistinguishable clinical picture. Rose spots and relative bradycardia were found only in a few patients. A total of 91% of the patients had a normal leukocyte count, which was associated with a markedly increased level of alanine aminotransferase in 82%. A total of 57% of the S. typhi isolates had decreased susceptibility to ciprofloxacin and resistance to nalidixic acid; these isolates were from southern Asia. Thirty percent were multidrug resistant; all were from southern Asia and Nigeria. None of the paratyphoid isolates were multidrug resistant but rates of decreased susceptibility to fluoroquinolones were higher than in S. typhi (74%).     

Cerebellar abscess caused by Listeria monocytogenes in a liver transplant patient

Brain abscesses are a rare but serious complication and have been documented in transplant recipients. Aspergillus is by far the most frequent etiology of post‐transplant brain abscesses. Bacteria, apart from Nocardia, have a low association with brain abscesses in transplant recipients. We report herein the case of a 52‐year‐old man who had undergone orthotopic liver transplantation (OLT) for end‐stage liver disease and hepatocellular carcinoma secondary to chronic hepatitis, and who developed a cerebellar abscess (CA) from Listeria monocytogenes. Three months after transplantation, he presented with a 1‐week history of headache and vomiting. Computed tomography scan of the brain revealed a space‐occupying lesion in the right cerebellum, which was further confirmed by magnetic resonance imaging. Emergency surgery was planned because of pressure effect on the surrounding structures. The patient recovered smoothly from the surgery. To our knowledge, no reports of Listeria CA following OLT have been published in the English literature. This case shows that, although extremely rare, L. monocytogenes may cause CA in liver transplant recipients, and clinicians should be aware of this, so that prompt diagnosis and treatment can be instituted before serious brain damage can occur.     

Enhancing chloramphenicol and trimethoprim in vitro activity by Ocimum sanctum Linn. (Lamiaceae) leaf extract against Salmonella enterica serovar Typhi

ObjectiveTo evaluate the antibacterial activity of Ocimum sanctum (O. sanctum) leaf extract, alone, and in combination with chloramphenicol (C) and trimethoprim (Tm) against Salmonella enterica serovar Typhi (S. typhi).MethodsThe antibacterial activity of ethanolic extract of tulsi, O. sanctum, leaf (TLE; 500 μg) for 23 S. typhi isolates was determined following agar diffusion. The C (30 μg) and Tm (5 μg) activity alone and in combination with TLE (250 μg) was determined by disk diffusion. The zone diameter of inhibition (ZDI) for the agents was recorded, and growth inhibitory indices (GIIs) were calculated.ResultsThe S. typhi isolates (n=23), which were resistant to both C (ZDI 6 mm) and Tm (ZDI 6 mm), had TLE (500 μg) ZDIs 16-24 mm. The ZDIs of C and Tm were increased up to 15-21 mm and 17-23 mm, respectively, when TLE (250 μg) was added to the C and Tm discs. The GIIs ranged 0.789-1.235 and 0.894-1.352, due to combined activity against S. typhi isolates, of C and TLE and Tm and TLE, respectively.ConclusionsThe data suggest that TLE, in combination with C and Tm, had synergistic activity for S. typhi isolates, and hence O. sanctum is potential in combating S. typhi drug resistance, as well promising in the development of non-antibiotic drug for S. typhi infection.     

Successful Treatment of <Emphasis Type="Italic">Ochroconis gallopavum</Emphasis> Infection in an Immunocompetent Host

Abstract Ochroconis gallopavum, a dematiaceous fungus, is a rare cause disease in immunocompromised patients and epidemic encephalitis in poultry. We report the first case of active O. gallopavum pulmonary infection in an immunocompetent host with rapid and complete response to oral antifungal therapy.     

Streptococcus pneumoniae Peritonitis Postpartum

Summary A peritonitis cause by an ascending infection is a rare complication postpartum. A 37-year-old women presented with a secondary peritonitis due to Streptococcus pneumoniae. The patient had given birth to a healthy boy 4 weeks before and showed no symptoms of a bronchitis on admission. A operation was performed after the patient developed an acute abdomen, showing a diffuse peritonitis. High vaginal swabs and blood cultures taken on admission were positive for S. pneumoniae as well as the specimen taken during the operation. Thus we concluded that this was a case of an ascending infection. After antibiotic therapy with penicillin the patient could be discharged 8 days after the operation. Received: July 6, 1999 · Accepted: January 5, 2000