Salmonella enterica meningitis in a neonate
Suhani Jain1, Ira Shah2
1Grant Government Medical College, Sir JJ Group of Hospitals, Mumbai, India, 2Consultant in Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India
Address for Correspondence: Suhani Jain, Flat number 402, Ramdeo Arise, Behind Hotel Airport Centre Pt, Wardha Road, Nagpur-440025.
Email: suhani2208@gmail.com
Keywords: Salmonella enterica, Meningitis, neonate
Clinical Problem :
A 15-day-old boy presented with a complaint of poor feeding and fever for two days. The child was previously alert and was breastfeeding normally since birth. He was born at full term by vaginal delivery and birth weight was 2.5 kg. Mother had no fever during pregnancy and there were no antenatal complications. He was admitted to the hospital for further evaluation and management. On examination, the neonate had a bulging anterior fontanelle and was lethargic. Heart rate was 130/min, respiratory rate was 36/min and blood pressure was 90/60 mm of Hg in right upper arm. Weight was 3.5 kg (25th centile as per World Health Organization (WHO) growth charts). Other general examination findings were normal. Systemic examination was normal. Other central nervous system examination findings were normal. Tone was normal. Cry was shrill. There were no focal neurological deficits in form of muscle weakness or paralysis. Meningeal signs could not be elicited. Investigations revealed hemoglobin of 14 gm/dl, white cell count of 17,500 cells/cumm (80% polymorphs, 19% lymphocytes), platelets of 1,98,000 cells/cumm and CRP of 110 mg/dl. Cerebrospinal fluid (CSF) analysis showed sugar 30.5 mg/dl with simultaneous blood sugar of 85 mg/dl, protein- 95mg/dl, nucleated cells- 60 cells/cumm (polymorphs-70% and lymphocytes 30%). CSF culture grew Salmonella enterica.
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How did the child get Salmonella enterica in the CSF and what would be the best possible treatment?
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