Salmonella D Meningitis in an Infant Complicated by Multiple Brain Abscesses: A Case Report

Abstract

Introduction: Salmonella meningitis is a rare but potentially fatal CNS infection in infants. Compared to common neonatal infectious pathogens such as Group B streptococcus and Escherichia coli, Salmonella poses a greater risk of severe complications, including cerebral abscesses, subdural collections, and long-term neurodevelopmental delays. Treatment can be difficult, even with early diagnosis, with no consensus on the optimal course of action.

Case Presentation:

A previously healthy 3-month-old female presented with two days of fever, poor feeding, and irritability. On admission, she was sick-looking with a tense anterior fontanel. High Protein, low glucose, and pleocytosis were revealed on initial CSF analysis, which suggested bacterial meningitis. She required intensive care, mechanical ventilation, and various anticonvulsants due to refractory seizures, even after receiving empiric ceftriaxone and vancomycin. Culture of blood and CSF led to the detection of Salmonella enterica serogroup D, sensitive to ampicillin and gentamicin; the treatment plan was modified accordingly. Neuroimaging discovered bilateral white matter edema, multiple frontal lobe abscesses, and subdural collections, requiring neurosurgical interventions like burr-hole aspiration and drainage. Patient's condition didn’t improve with prolonged antimicrobial medication; subsequent follow-ups revealed persistent seizures, developmental delays, including poor head control, and failure to meet milestones on consequent follow-ups.

Discussion:

Salmonella infections typically cause self-limiting gastroenteritis; this case illustrates the rare manifestations of Salmonella D. Diagnosis remains challenging, as clinical manifestations resemble those of more common bacterial meningitis. The prognosis of patients remains poor, with substantial rates of neurological sequelae and high mortality rates. This case emphasizes the importance of suspecting rare etiologies, early diagnosis, repeated neuroimaging, and long-term follow-up to monitor and control complications such as abscesses, empyema, and epilepsy.

Conclusion:

Salmonella meningitis in infants, although rare, poses a high risk of fatality. Thus should be ruled out in suspected cases. Our case shows its aggressive progression, resistance to standard management, and serious neurological complications. Early detection, targeted antibiotics, and neuroimaging are essential; however, long-term outcomes remain uncertain.

Keywords: Salmonella meningitis, Non-typhoidal Salmonella, Infant meningitis, Brain abscess, Neurodevelopmental sequelae, Epileptic encephalopathy, Pediatric central nervous system infection