Nontyphoidal salmonellae (NTS) are important foodborne pathogens. Mild to moderate gastroenteritis in healthy young adults is often self-limiting and requires no antibiotic treatment. Compromised hosts can develop severe disease complicated by bacteraemia and focal infection which may lead to devastating consequences. Bacteraemia, especially if it occurs without gastrointestinal symptoms should prompt careful clinical and microbiological evaluation. Appropriate antibiotics given in the correct doses for the recommended duration is vital for satisfactory outcome to completely eliminate the infection and prevent recurrences. Medical therapy should be combined with surgical management when indicated. Rational and controlled antibiotic use in human, veterinary and agriculture practices is essential to counter the increasing resistance that is developing in Salmonella worldwide. Adherence to good food hygiene practices will help prevent infections. We describe a case series of NTS bacteraemia in patients with underlying compromised conditions detected over a period of six months in the Microbiology Department of the National Hospital of Sri Lanka.

Introduction: Diarrhoeal diseases are an important public health problem in Sri Lanka. Objectives:To determine the organisms that caused diarrhoea, the clinical profile, sociodemographic details including living conditions, microbiological analysis and response to treatment. Method:A retrospective study was done from October 2014 to January 2015. Hospital records were used to analyse living conditions, water supply and general wellbeing of the children in addition to clinical and microbiological data.Results: A total of 346 (4% of total admissions) cases were admitted with diarrhoeal illness to the paediatric wards during the study period. One hundred and twenty one (35%) children had blood and mucous diarrhoea of whom Shigella sp. was isolated from the stools of 15. The mean age of children with proven shigellosis was 2.3±1.1years. Seven of the patients with proven shigellosis had poor growth indicated by the low weight for height i.e. between the -2SD and -3SD. Shigella flexneri II was identified in 14 patients and Shigella sonnei from one patient. Eight (53%) patients with S. flexneri were treated with IV gentamicin to which there was a clinical response. Majority (12) of the households did not have a proper water supply and 10 families had to travel >5 km to get clean drinking water facilities. All 15 cases demonstrated poor hygienic practices.Conclusions: Blood and mucus diarrhoea accounted for 121 of 346 admissions for diarrhoea during a 4 month period in Jaffna Hospital. A positive aetiological diagnosis was made in only 15 patients, with S. flexneri isolated from 14 and S. sonnei from one patient.

Prosthetic valve replacement is one of the predisposing factors for the development of infective endocarditis. Prosthetic valve infective endocarditis caused by non typhoidal Salmonellae is an uncommon manifestation. We report a case of a female patient with a history of bioprosthetic aortic valve replacement admitted due to prolonged fever with diarrhoea. The echocardiogram revealed a prosthetic valve vegetation with the etiological diagnosis of infective endocarditis by Salmonella enterica Serovar Enteritidis. She had a fulminant clinical course and died after 6 months despite prolonged antibiotic treatment.

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