A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient
Abstract Background Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive is...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-09-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-4391-7 |
| _version_ | 1818333722418610176 |
|---|---|
| author | Roxanne Rule Nontombi Mbelle John Osei Sekyere Marleen Kock Anwar Hoosen Mohamed Said |
| author_facet | Roxanne Rule Nontombi Mbelle John Osei Sekyere Marleen Kock Anwar Hoosen Mohamed Said |
| author_sort | Roxanne Rule |
| collection | DOAJ |
| description | Abstract Background Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive isolate such as cerebrospinal fluid (CSF). Colistin resistance has important infection control implications and failure to manage this phenomenon may lead to the loss of our last line of defence against multi-drug resistant Gram-negative organisms. To our knowledge, this is the first reported clinical case of colistin-resistant Salmonella Enteritidis meningitis in South Africa. Case presentation We report a case of a young male patient with advanced human immunodeficiency virus (HIV) infection who presented to hospital with symptoms of meningitis. Cerebrospinal fluid (CSF) cultured a Salmonella Enteritidis strain. Antimicrobial susceptibility testing (AST) of the isolate, revealed the strain to be colistin resistant. Despite early and aggressive antimicrobial therapy, the patient succumbed to the illness after a short stay in hospital. Subsequent genomic analysis of the isolate showed no presence of the mcr genes or resistance-conferring mutations in phoPQ, pmrAB, pmrHFIJKLME/arnBCADTEF, mgrB, and acrAB genes, suggesting the presence of a novel colistin resistance mechanism. Conclusion Invasive non-typhoidal salmonellae infection should be suspected in patients with advanced immunosuppression who present with clinical features of meningitis. Despite early and appropriate empiric therapy, these infections are commonly associated with adverse outcomes to the patient. Combination therapy with two active anti-Salmonella agents may be a consideration in the future to overcome the high mortality associated with NTS meningitis. Colistin resistance in clinical Salmonella isolates, although a rare finding at present, has significant public health and infection control implications. The causative mechanism of resistance should be sought in all cases. |
| first_indexed | 2024-12-13T13:56:09Z |
| format | Article |
| id | doaj.art-919e7b0d3efa4f6c8513c41cbabf8249 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T13:56:09Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-919e7b0d3efa4f6c8513c41cbabf82492022-12-21T23:42:53ZengBMCBMC Infectious Diseases1471-23342019-09-011911710.1186/s12879-019-4391-7A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patientRoxanne Rule0Nontombi Mbelle1John Osei Sekyere2Marleen Kock3Anwar Hoosen4Mohamed Said5Department of Medical Microbiology, Pathology Building, University of PretoriaDepartment of Medical Microbiology, Pathology Building, University of PretoriaDepartment of Medical Microbiology, Pathology Building, University of PretoriaDepartment of Medical Microbiology, Pathology Building, University of PretoriaVermaak and Partners Pathologists, Unitas Hospital, Corner of Rabie Street and Clifton AvenueDepartment of Medical Microbiology, Pathology Building, University of PretoriaAbstract Background Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive isolate such as cerebrospinal fluid (CSF). Colistin resistance has important infection control implications and failure to manage this phenomenon may lead to the loss of our last line of defence against multi-drug resistant Gram-negative organisms. To our knowledge, this is the first reported clinical case of colistin-resistant Salmonella Enteritidis meningitis in South Africa. Case presentation We report a case of a young male patient with advanced human immunodeficiency virus (HIV) infection who presented to hospital with symptoms of meningitis. Cerebrospinal fluid (CSF) cultured a Salmonella Enteritidis strain. Antimicrobial susceptibility testing (AST) of the isolate, revealed the strain to be colistin resistant. Despite early and aggressive antimicrobial therapy, the patient succumbed to the illness after a short stay in hospital. Subsequent genomic analysis of the isolate showed no presence of the mcr genes or resistance-conferring mutations in phoPQ, pmrAB, pmrHFIJKLME/arnBCADTEF, mgrB, and acrAB genes, suggesting the presence of a novel colistin resistance mechanism. Conclusion Invasive non-typhoidal salmonellae infection should be suspected in patients with advanced immunosuppression who present with clinical features of meningitis. Despite early and appropriate empiric therapy, these infections are commonly associated with adverse outcomes to the patient. Combination therapy with two active anti-Salmonella agents may be a consideration in the future to overcome the high mortality associated with NTS meningitis. Colistin resistance in clinical Salmonella isolates, although a rare finding at present, has significant public health and infection control implications. The causative mechanism of resistance should be sought in all cases.http://link.springer.com/article/10.1186/s12879-019-4391-7Salmonella EnteritidisNon-typhoidal SalmonellaMeningitisHIVColistin resistance |
| spellingShingle | Roxanne Rule Nontombi Mbelle John Osei Sekyere Marleen Kock Anwar Hoosen Mohamed Said A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient BMC Infectious Diseases Salmonella Enteritidis Non-typhoidal Salmonella Meningitis HIV Colistin resistance |
| title | A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient |
| title_full | A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient |
| title_fullStr | A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient |
| title_full_unstemmed | A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient |
| title_short | A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient |
| title_sort | rare case of colistin resistant salmonella enteritidis meningitis in an hiv seropositive patient |
| topic | Salmonella Enteritidis Non-typhoidal Salmonella Meningitis HIV Colistin resistance |
| url | http://link.springer.com/article/10.1186/s12879-019-4391-7 |
| work_keys_str_mv | AT roxannerule ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT nontombimbelle ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT johnoseisekyere ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT marleenkock ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT anwarhoosen ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT mohamedsaid ararecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT roxannerule rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT nontombimbelle rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT johnoseisekyere rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT marleenkock rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT anwarhoosen rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient AT mohamedsaid rarecaseofcolistinresistantsalmonellaenteritidismeningitisinanhivseropositivepatient |