Pyogenic spondylitis and paravertebral abscess caused by Salmonella Saintpaul in an immunocompetent 13-year-old child: a case report

Abstract

BackgroundSalmonella spondylitis is an uncommon complication of Salmonella infection in immunocompetent children. To prevent treatment failure and neurological deficits, it needs prompt diagnosis and sufficient effort to identify the causative organism. There are some options to identify the causative organism such as Computed Tomography (CT) guided biopsy or surgical debridement, however when to perform these invasive interventions remains controversial.Case presentationA 13-year-old boy presented with occasional high fever and lower back pain. He was diagnosed with spondylitis of the L4–5 vertebral bodies and paravertebral abscess. Initial blood cultures were negative, therefore empirical antibiotic treatment was started. He responded well to conservative management, and was discharged after clinical improvement. However, he was re-hospitalized 2 weeks after discharge, and surgical debridement was performed which led to the detection of Salmonella Saintpaul as the causative pathogen. It was revealed that the possible source of infection was consumption of raw poultry eggs, or contact with poultry. Definitive antibiotic therapy was started. He was discharged with good recovery after a 6-week hospitalization.ConclusionsThis is the very first case report of pyogenic spondylitis caused by Salmonella Saintpaul. Salmonella should be considered as a causative pathogen of pyogenic spondylitis in immunocompetent children. Identifying the causative organism is essential to prevent treatment failure, and a high index of suspicion is needed for prompt diagnosis especially when blood cultures are negative. Invasive interventions such as CT-guided biopsy should be considered even if the clinical course seems to be uncomplicated.

A Systematic Review of the Diagnosis and Treatment of Non-Typhoid Salmonella Spondylodiscitis in Immunocompetent Children

“…In 8/21 (38.09%) computed tomography (CT) of the affected region was performed, and the diagnosis of spondylodiscitis was established [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. An MRI of the affected region was performed in 13/21 of the cases reviewed (61.9%) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

“…Cotrimoxazole and ampicillin were given in two cases (9.5%). Treatment was continued for an average of 9.61 weeks (95% CI, 6–18 weeks) [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Salmonella enteritis Spondylitis with Brucella melitensis Infection: A Rare Case of Mixed Infections of Spine

“…7 There has been an increase in Salmonella-induced spondylitis in recent years. 6,[8][9][10][11][12][13][14][15][16] Spondylitis caused by Salmonella enteritis and B. melitensis has not been reported to date. An unusual mixed infection characterizes this case.…”

Torticollis in a 7-year-old child: an alarming sign not to be turned away

“…Його метицилінрезистентний штам (MRSA) у 30-40% є причиною кістково-суглобових інфекцій у США і 30-63% -у Європі [3,19,44]. Іншим, поширеним збудником ГО, є Mycobacterium tuberculosis, на долю якої припадає 9-46% випадків інфекцій хребта в розвинутих країнах [31,43]. Останніми роками патогеном, що з'явився в етіології гострої кістково-суглобової інфекції в дітей віком до 5 років, є Kingella kingae, раніше відомий як Moraxella kingae.…”

“…Диференційна діагностика ГО атласу пов'язана з широким спектром захворювань і казуїстичних випадків. Наприклад, це можуть бути гострий лімфобластний лейкоз, шийний лімфаденіт, спондилодисцит, остеомієліт шийних хребців [1,7,18,34,42,50] і туберкульоз шийного відділу хребта [29], паратонзилярний абсцес, травматичний підвивих шийних хребців [20,27] і синдром Гризеля [35], інтра-, епіду-ральні, паравертебральні абсцеси [1,31,41] і пневмонія [2], арахноїдальна кіста [2] та латероцервікальний абсцес унаслідок мігруючого стороннього тіла [32]. Диференційний діагноз є досить широким і має включати всі органи й системи.…”