Egyptian Journal of Medical Microbiology Volume 27 / No.3 / July 2018 93-96 Online ISSN: 2537-0979 Egyptian Journal of Medical Microbiology www.ejmm-eg.com info@ejmm-eg.com 93 CASE REPORT Salmonella typhi Meningitis in an Infant: A Case Report 1,3 Abdelrahman M. Elsawy, 1,2 Hani S. Faidah, 4 Kamal M. Balkhoyor, 2 Hamdi M. AlSaid * , 2 Sami S. Ashgar 1 Medical Microbiology Department, Al-Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia 2 Department of Microbiology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia 3 Department of Microbiology, Al-Azhar Faculty of Medicine, Cairo, Egypt 4 Department of Neurosurgery, Al-Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia ABSTRACT Key words: Salmonella typhi, meningitis, infant, Cerebrospinal fluid *Corresponding Author: Hamdi M. AlSaid Department of Microbiology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia 00201091823462- 00966551941735 hamdimustafa1@gmail.com Salmonella typhi is a rare cause of purulent meningitis. We reported a case of meningitis due to S. typhi in five month old Indian male infant. Diagnosis was established based on Cerebrospinal fluid (CSF) findings and blood culture. The infant responded well to prolonged systemic antibiotics and recovered completely without any neurological complications after proper surgical and supportive measures. Child was also followed up for 5 months and found to be doing well without any sequelae. The importance of bacteriological diagnosis and prolonged antibiotic treatment for S. typhi meningitis is discussed. INTRODUCTION Meningitis due to salmonella group is relatively uncommon condition but is an important public health problem in developing countries, because of high mortality and morbidity rates associated with poor socioeconomic status and poor hygienic practice especially in infants and young children 1-3 . Regardless of the use of appropriate antibiotic therapy, the mortality due to salmonella infections is very high during early infancy and the chance of relapse in the survivors is very high. We are reporting an infant with S.typhi meningitis with subdural collection. CASE PRESENTATION A five month-old, Indian male infant was presented to the Emergency Department in an Tertiary Care Hospital, Makah, Saudi Arabia, with a history of intermittent fever one week ago. The patient gradually became lethargic and irritable. Enlargement of the head was also noticed. There was no history of cough, jaundice, rashes, or ear discharge. Assessment of vital signs on presentation revealed a temperature of 39.6°C, pulse of 110 beats per minute, and blood pressure of 80/40 mmHg. The physical examination revealed that the infant was toxic, irritable, drowsy with tense anterior fontanel, and a head circumference of 46.0 cm. Cardiovascular and respiratory systems were normal. Laboratory investigations revealed hemoglobin 9.5g/dl, total leukocyte count 13,900 cells per cubic millimeter. Liver and renal function tests, serum electrolytes, calcium and magnesium were within normal limits (Table 1) Table 1: Patient's parameters on admission WBC'S 13.9 (10 3 /μl) Hb 9.5 (g/dl) Urea 11 (mg/dl) Creatinine 0.3 (mg/dl) Blood glucose 96 (mg/dl) Sodium –Na 128 (mmol/L) Potassium – K 4.3 (mmol/L) ALT 36 (IU/l) AST 28 ( IU/l) Bilirubin, total 0.30 (mg/dl) Bilirubin, direct 0.09 (mg/dl) Alkaline Phosphatase 149 (IU/L) In view of suspected central nervous system infection, lumbar puncture was done. Cerebrospinal fluid (CSF) analysis showed an elevated protein level of 460 mg/dl (reference range, 15 to 45) and low glucose concentration of 1 mg/dl (reference range of 40 to 70 mg/dl). Gram stain of CSF showed no bacteria, but white blood cells were increased 209.700 (10 3 /μl with 96% neutrophils. With the conclusion of pyogenic meningitis, patient was started on intravenous ceftriaxone (100mg/kg/day) and infant became afebrile within 48 hours of starting antibiotics. A non-contrast computed tomography (CT) of the head showed bilateral subdural collection with mixed density compressing the right cerebrum, bilateral subdural drainage were done to relive the compression (Figure 1).