A clinical audit of presentation and outcome of salmonella septicaemia

Abstract

Introduction: Enteric fever is imported to developed countries while non-typhoidal salmonella infections occur globally. Clinicians and trainees need to recognise the varied presentations of serious salmonella infections. Materials and Methods: We reviewed the clinical presentations, hospital course, complications and outcomes of 50 patients who were blood culture positive for Salmonella spp seen in 2 years. Results: Nineteen of 24 patients with enteric fever had recently travelled to Asian countries. All the enteric fever patients recovered fully. Out of 26 patients with non-typhoidal salmonellosis, 10 had malignancies, 7 had immune dysfunction states and 3 had aortic aneurysms. Five patients had recurrent episodes of salmonellosis. Eight of these patients who had cancer (4), diabetes mellitus with renal failure (2) and gastric diseases (2) died. Fatal cases were older with multiple admissions and co-morbidities (median, 3) and presentation followed immunosuppressive interventions, often with no fever (4). Onset was sudden with a short and fatally unresponsive course despite effective antimicrobial agents with microbiologic diagnosis made posthumously (4). Death resulted rapidly from overwhelming sepsis and aneurysmal complications. Antibiotic resistance to ampicillin, cotrimoxazole and chloramphenicol was noted. Conclusion: Enteric fever should be considered in travellers returning from Asian countries with fever, and third-generation cephalosporins or quinolones should be used for empiric treatment. Given the presentation of non-typhoidal salmonella septicaemias, clinicians need to have a high index of suspicion and to consider preemptive therapy in patients with prior infection who are likely to develop severe immunosuppression following interventions.