Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(02): 164-170
DOI: 10.4103/JLP.JLP_165_18
Case Report

Salmonella osteomyelitis: A rare extraintestinal manifestation of an endemic pathogen

Ranjana Rohilla
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Mohit Bhatia
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Pratima Gupta
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Arpana Singh
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Ravi Shankar
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Balram Ji Omar
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Author Affiliations Financial support and sponsorship Nil
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

Salmonella enterica serovar Typhi and Paratyphi usually cause enteric fever in humans characterized by fever and gastrointestinal symptoms such as diarrhea. Bacteremia is a constant feature of enteric fever, and occasionally, dissemination of bacilli throughout the body results in the establishment of one or more localized foci of persisting infection. This happens especially in patients with preexisting conditions such as hemoglobinopathies, previous joint trauma, surgery, connective tissue diseases, lymphoma, diabetes, alcoholism, immunosuppressive state, and extremes of ages. Rarely, these extraintestinal Salmonella infection cases have also been reported in immunocompetent individuals without any obvious predisposing factors. Salmonella osteomyelitis, a rare sequelae of typhoid, may occur as a result of hematogenous seeding of the bone or joints due to a bacteremic episode. It may also spread from nearby areas of infection or penetrating trauma. Timely diagnosis and treatment of this condition are necessary because if left untreated, it can lead to permanent functional deficits later on. We hereby present a case series with brief review of literature on Salmonella osteomyelitis in immunocompetent patients without any known predisposing conditions over a period of 1 year (2017–2018) from a Tertiary Care Teaching Hospital in Uttarakhand, India.

Key words

Enteric fever - immunocompetent - Salmonella osteomyelitis


Publication History

Received: 08 December 2018

Accepted: 13 February 2019

Article published online:
06 April 2020

© 2019.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Popoff MY, Minor LL. WHO collaborating centre for reference and research on Salmonella. Antigenic Formulas of the Salmonella Serovars. 7th Revision. Paris, France: Institut Pasteur; 1997.
  • 2 Giannella RA. Salmonella. In: Baron S, editor. Medical Microbiology. 4th ed., Ch 21. Galveston (TX); Univ of Texas Medical Branch: 1996.
  • 3 World Health Organization. Typhoid. World Health Organization; 2018. Available from: http://www.who.int/immunization/diseases/typhoid/en/. [Last updated 2018 Sep 11; Last accessed 2018 Sep 20].
  • 4 Kaistha N, Gupta V, Sidhu S, Chander J. Salmonella-salmonellosis-rare presentations of a common pathogen. Asian Pac J Trop Med 2011;4:417-20.
  • 5 Arora A, Singh S, Aggarwal A, Aggarwal PK. Salmonella osteomyelitis in an otherwise healthy adult male-successful management with conservative treatment: A case report. J Orthop Surg (Hong Kong) 2003;11:217-20.
  • 6 Old DC. Salmonella. In: Collee JG, Fraser, AG, Marmion BP, Simmons A, editors. Mackie and Mccartney Practical Medical Microbiology. 14th ed. New Delhi: Elsevier; 2014. p. 385-402.
  • 7 Gupta P, Kaistha N, Omar BJ, Gupta P, Singh V, Mohanty A. Salmonella typhi: A cause of septic arthritis knee: A rare entity. Int J Biomed Res 2017;8:242-4.
  • 8 Mohanty A, Pandita N, Kandwal P, Omar BJ, Gupta P, Gupta P. Salmonella osteomyelitis of the lumbar spine: An unusual presentation in an immunocompetent male. Asian J Pharm Clin Res 2018;11:1-2.
  • 9 Kothari A, Pruthi A, Chugh TD. The burden of enteric fever. J Infect Dev Ctries 2008;2:253-9.
  • 10 Huang DB, DuPont HL. Problem pathogens: Extra-intestinal complications of Salmonella enterica serotype typhi infection. Lancet Infect Dis 2005;5:341-8.
  • 11 McAnearney S, McCall D. Salmonella osteomyelitis. Ulster Med J 2015;84:171-2.
  • 12 Sanchez AA, Mazurek MT, Clapper MF. Salmonella osteomyelitis presenting as fibrous dysplasia. A case report. Clin Orthop Relat Res 1996;330:185-9.
  • 13 Anand AJ, Glatt AE. Salmonella osteomyelitis and arthritis in sickle cell disease. Semin Arthritis Rheum 1994;24:211-21.
  • 14 Gupta V, Priyadarshi A, Mehra N, Yadav TP, Dewan V. Salmonella typhi causing hip arthritis with dislocation. JIACM 2014;15:141-2.
  • 15 Phadke PS, Gandhi AR, More SA, Joshirao RP. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case. J Postgrad Med 2017;63:44-6.
  • 16 Gupta R, Awasthi R, Pauranik A. Salmonella vertebral osteomyelitis of thoracic spine. J Spine Surg 2014;1:135-7.
  • 17 Banerjee B, Madiyal M, Madhava PK, Agarwal M, Mukhopadhyay C. Typhoid spondylodiscitis mimicking tuberculosis in a teenage girl. J Infect Public Health 2018;11:136-7.
  • 18 Lakshmi K, Santhanam R. Thoracic spinal osteomyelitis due to Salmonella enteritidis in an immunocompetent mimicking tuberculosis. J Neurosci Rural Pract 2016;7:317-9.
  • 19 Sudhaharan S, Padmaja K, Solanki R, Lakshmi V, Umabala P, Aparna B, et al. Extra-intestinal salmonellosis in a tertiary care center in South India. J Infect Dev Ctries 2014;8:831-7.
  • 20 Ranjith TC, Bhaskaran VK. Salmonella typhi osteomyelitis in healthy young adult. Kerala J Orthop 2013;26:113-5.
  • 21 Mathuram A, Rijn RV, Varghese GM. Salmonella typhi rib osteomyelitis with abscess mimicking a 'cold abscess'. J Glob Infect Dis 2013;5:80-1.
  • 22 Shanthi M, Sekar U, Sridharan KS. Septic arthritis of hip caused by Salmonella typhi: A case report. Case Rep Infect Dis 2012;2012:464527.
  • 23 Faseela TS, Malli CS, Balakrishna AK, Gomes L, Nayak N. Salmonella typhi septic arthritis of the hip – A case report. J Clin Diagn Res 2010;4:2308-10.
  • 24 Bhooshan P, Shivaprakasha S, Dinesh KR, Kiran M, Karim P. Chronic subdural empyema and cranial vault osteomyelitis due to Salmonella paratyphi A. Indian J Med Microbiol 2010;28:60-2.
  • 25 Papaioannou I, Baikousis A, Korovessis P. Multi-foci Salmonella enteritis osteomyelitis of thoracic spine with pleural effusion and fatal outcome. A unique case presentation and review of the literature. J Orthop Case Rep 2017;7:69-74.
  • 26 Zaid B, Jebaje AL, Zhao A, Samannodi M, Al-Sofiani M, Hocko M. Salmonella spondylitis in an immunocompetent non-sickle cell patient. Int J Case Rep 2017;8:187-90.
  • 27 Shrestha P, Mohan S, Roy S. Bug on the back: Vertebral osteomyelitis secondary to fluoroquinolone resistant Salmonella typhi in an immunocompetent patient. BMJ Case Rep 2015;2015. pii: bcr2015212503.
  • 28 Khoo HW, Chua YY, Chen JL. Salmonella typhi vertebral osteomyelitis and epidural abscess. Case Rep Orthop 2016;2016:6798157.
  • 29 Oki M, Ueda A, Tsuda A, Yanagi H, Ozawa H, Takagi A, et al. Salmonella enterica serotype enteritidis vertebral osteomyelitis and epidural abscess complicated with meningitis. Tokai J Exp Clin Med 2016;41:169-71.
  • 30 Tonogai I, Hamada Y, Hibino N, Sato R, Henmi T, Sairyo K, et al. Salmonella osteomyelitis of the distal radius in a healthy young adult patient: Report of a rare case and literature review. J Med Invest 2015;62:97-9.
  • 31 Scarci M, Attia R, Phipps KH. Look what's eroding through the chest wall? Salmonella osteomyelitis of the ribs in an immunocompetent adult not associated with sickle cell disease. Ann R Coll Surg Engl 2010; 92:59-61.
  • 32 Le Doare K, Brooker E, Ladhani S. Travel-associated Salmonella mbandaka sacroiliac osteomyelitis in a healthy adolescent. Case Rep Infect Dis 2013;2013:543147.
  • 33 Kim BK, Dan J, Lee YS, Kim SH, Cha YS. Salmonella osteomyelitis of the femoral diaphysis in a healthy individual. Am J Orthop (Belle Mead NJ) 2014;43:E237-9.
  • 34 Martínez-Serrano M, Arranz-Solana C, Martínez-Alfaro E, Crespo-Sánchez MD. Right knee pain, swelling and fever in a young immunocompetent male. Enferm Infecc Microbiol Clin 2014;32:396-7.
  • 35 Salem KH. Salmonella osteomyelitis: A rare differential diagnosis in osteolytic lesions around the knee. J Infect Prev 2014;7:66-9.
  • 36 Uygur E, Reddy K, Ozkan FÜ, Söylemez S, Aydin O, Senol S. Salmonella enteridis septic arthritis: A report of two cases. Case Rep Infect Dis 2013;2012:3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819818/pdf/CRIM.ID2013-642805.pdf. [Last accessed on 2018 Sep 20].
  • 37 Alhazzazi KM, Alsheikh K, Konbaz F, AlMugren TS. Salmonella species causing hip septic arthritis. Int J Community Med Public Health 2018;5:3146-8.
  • 38 Ayeni IV, Calver G. Ciprofloxacin resistant osteomyelitis following typhoid fever. BMJ Case Rep 2012;2012. pii: bcr0320126107.
  • 39 Angela HW, Tong CS, Lam CW, Hung YC, Cheung WW. Salmonella osteomyelitis of the pelvis in healthy adults: A case report. J Orthop Trauma Rehabil 2011;15:27-8.
  • 40 Zhang Y. Persisters, persistent infections and the yin-yang model. Emerg Microbes Infect 2014;2012:6. Available from: https://www.nature.com/articles/emi20143.pdf. [Last accessed on 2018 Sep 20].
  • 41 Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364:369-79.