CP4 -Non-typhoidal salmonella meningitis in an infant: A case report

Abstract

Introduction

Non-typhoidal Salmonella (NTS) typically causes gastroenteritis but rarely leads to invasive disease, including meningitis. We report a case of NTS meningitis in a 5-month-old female infant caused by Salmonella paratyphi B var Java, highlighting the importance of microbiological diagnosis and antimicrobial susceptibility testing in clinical management.

Case Report

A previously healthy 5-month-old girl presented with one day of fever followed by focal convulsions and three days of profuse diarrhea. Her mother and sibling had concurrent diarrheal illness, and there was a recent history of flooding in their residential area. Despite exclusive breastfeeding, the infant received supplementary boiled water via spoon daily. Initial examination revealed fever and irritability with normal hydration status. Laboratory investigations showed leukocytosis (WBC 20,000/μL with 82% neutrophils) and elevated C-reactive protein (154 mg/dL). Lumbar puncture findings were consistent with partially treated bacterial meningitis, including elevated CSF protein (339 mg/dL), pleocytosis (50 polymorphs/mm³, 240 lymphocytes/mm³), and low CSF glucose (22 mg/dL).

Blood culture yielded Salmonella paratyphi B var. Java, which was susceptible to multiple antibiotics, including cefotaxime, but showed intermediate susceptibility to ciprofloxacin. CSF culture remained sterile, and stool culture was negative for Salmonella. Following initial empiric treatment with cefotaxime, therapy was briefly escalated to meropenem due to persistent fevers but later de-escalated back to cefotaxime based on susceptibility results. The patient completed a 21-day course of antibiotics with significant clinical improvement and normalization of CSF parameters.

Discussion

This case highlights the importance of considering NTS in the differential diagnosis of bacterial meningitis in infants, particularly in developing regions with poor sanitation or following environmental contamination events, such as flooding. The successful outcome underscores the value of blood cultures prior to antibiotic initiation, appropriate antibiotic selection based on susceptibility testing, and extended treatment courses for invasive NTS infections. Public health measures, including improved sanitation and exclusive breastfeeding without supplementary water in young infants, are crucial preventive strategies against this potentially devastating infection