Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2012  |  Volume : 4  |  Issue : 1  |  Page : 89-

Salmonella paratyphi neck abscess


Bijayini Behera1, Jagadishwar Goud2, A Kamlesh3, Yashwant K Thakur4,  
1 Department of Microbiology, Yashoda Superspeciality Hospital, Andhra Pradesh, India
2 Department of Surgical Oncology, Yashoda Superspeciality Hospital, Andhra Pradesh, India
3 Department of Internal Medicine, Yashoda Superspeciality Hospital, Andhra Pradesh, India
4 National Salmonella and E coli centre, Central Research Institute, Kasauli, Himachal Pradesh, India

Correspondence Address:
Bijayini Behera
Department of Microbiology, Yashoda Superspeciality Hospital, Andhra Pradesh
India




How to cite this article:
Behera B, Goud J, Kamlesh A, Thakur YK. Salmonella paratyphi neck abscess .J Global Infect Dis 2012;4:89-89


How to cite this URL:
Behera B, Goud J, Kamlesh A, Thakur YK. Salmonella paratyphi neck abscess . J Global Infect Dis [serial online] 2012 [cited 2020 Oct 20 ];4:89-89
Available from: https://www.jgid.org/text.asp?2012/4/1/89/93770


Full Text

Sir,

Head and neck infections normally arise from Streptococcus, Staphylococcus, or other anaerobic species, and infection by Salmonella is rare. [1] According to a recent review, there have been about 10 cases of neck abscesses with soft tissue involvement by various non-typhoidal Salmonella (NTS) serovars, reported worldwide in the last 10 years. [2] Salmonella paratyphi A, one of the causative agents of enteric fever, has rarely been implicated in focal suppurative complications. [3],[4],[5],[ 6] This report presents the first ever case of neck abscess caused by Salmonella paratyphi A, a typhoidal Salmonella serovar, without classical presentations of enteric fever, in a young male without any known predisposing factors.

A 22-year-old male was referred with a complaint of painful swelling involving entire right neck for seven days. On admission, the patient was febrile with a body temperature of 37.6°C. On physical examination, there was gross cellulitis involving the right neck, with tenderness, local rise of temperature, and the overlying skin appeared slightly erythematous. Laboratory findings revealed white cell count of 13.2×10 9 /L with 86% neutrophils, 6.0% lymphocytes; hemoglobin 14.8 g/dL, hematocrit 44%, platelet count 1.81×10 9 /L. On ultrasonography of neck, there was gross cellulitis with soft tissue edema; abscess was seen confined to the neck measuring 30 mm × 40 mm with associated cervical lymphadenopathy. Under local anesthesia, incision and drainage of the abscess was performed and the patient was empirically started on intravenous amoxicillin-clavulanic acid. Gram stain of the purulent material revealed plenty of polymorphonuclear cells, and no microorganisms, later on culture, pure growth of smooth, translucent; non-lactose fermenting colonies were obtained on MacConkey agar. The isolate was identified as Salmonella paratyphi A by conventional biochemical reactions and by MicroScan Walk-Away 40® (Dade Behring Inc., West Sacramento, CA). The Salmonella isolate was sent for serotyping to National Salmonella reference centre, Kasauli, Himachal Pradesh, India, and was identified as Salmonella paratyphi A (2, 12: a:-). The isolate was sensitive to amikacin, ampicillin, ampicillin/sulbactam, amoxicillin-clavulanic acid, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole and tobramycin. Blood cultures obtained at days 1 and 3 of admission were found to be sterile. Patient was discharged home in a stable condition. Amoxicillin-clavulanic acid, to which the isolate was susceptible, was continued for total period of three weeks. After initial clinical improvement for one month, the patient was again admitted with similar complaints. Incision and drainage was done and culture of the aspirate revealed pure growth of Salmonella paratyphi A with identical antimicrobial susceptibility. Repeat blood and urine cultures were found to be sterile. Stool culture did not reveal the presence of Salmonella paratyphi. Widal test was negative. Patient was found to be HIV sero-negative. Patient was advised oral moxifloxacin 400 mg for 4 weeks. Clinical examination reported satisfactory outcome at three months and six months of follow-up, with no recurrence of infection.

The conventional treatment modality for a Salmonella neck abscess involves incision and drainage, and treatment with the appropriate antibiotics for a minimum of three weeks. [2] In the present case, there was recurrence of infection, despite the Salmonella paratyphi A isolate being susceptible to amoxicillin-clavulanic acid. The long-term administration of oral quinolone was considered necessary to prevent future recurrence.

References

1Reynolds SC, Chow AW. Severe soft tissue infections of the head and neck: A primer for critical care physicians. Lung 2009; 187:271-79.
2Kwon MH, Kang MI, Chun JY, Lim HW, Yeum YS, Kang YW, et al. A case of neck abscess caused by Salmonella serotype D in a patient with liver cirrhosis. Yonsei Med J 2010;51:128-30.
3D'Cruz S, Kochhar S, Chauhan S, Gupta V. Isolation of Salmonella paratyphi A from renal abscess. Indian J Pathol Microbiol 2009;52:117-9.
4Chaudhry R, Mahajan RK, Diwan A, Khan S, Singhal R, Chandel DS, et al. Unusual presentation of enteric fever: Three cases of splenic and liver abscesses due to Salmonella typhi and Salmonella paratyphi A. Trop Gastroenterol 2003;24:198-9.
5Lalitha MK, John R. Unusual manifestations of salmonellosis-A surgical problem. Q J Med 1994;87:301-9.
6Fule RP, Saroji AM. Isolation of Salmonella paratyphi A from thyroid abscess: A case report. Ind J Med Sci 1989:43:95-6.