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LETTER TO EDITOR
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 153

Salmonella infection in newborn - varied presentation from sepsis to shock


Tata Motors Hospital, Jamshedpur, Jharkhand, India

Date of Web Publication18-Oct-2013

Correspondence Address:
Rajiv Sharan
Flat No. 2223, Vijayagardens, Baridih, Jamshedpur - 831 017, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.120015

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How to cite this article:
Sharan R, Kumar S. Salmonella infection in newborn - varied presentation from sepsis to shock. J Clin Neonatol 2013;2:153

How to cite this URL:
Sharan R, Kumar S. Salmonella infection in newborn - varied presentation from sepsis to shock. J Clin Neonatol [serial online] 2013 [cited 2020 Jul 13];2:153. Available from: http://www.jcnonweb.com/text.asp?2013/2/3/153/120015

Sir,

 Salmonella More Details typhi infection is a global major public health problem. It affects millions of individuals and results in significant mortality. [1] Newborn babies are less likely to suffer from Salmonella as there is less likely hood of vertical or horizontal transmission in them. [2],[3] We present here two cases of Salmonella infection in newborn.

A single term male baby was delivered by normal vaginal delivery with meconium stained amniotic fluid and leaking for more than 6 h with birth weight of 2.4 kg. The baby was shifted to mother after initial steps of resuscitation and continued on breast feeding. As per hospital policy hemoglobin, total leukocyte count (TLC), differential leukocyte count (DLC), and blood group were sent. No prelacteals were administered to the baby. Sixty hours after birth the baby developed fever, lethargy, and refusal to feed. Sepsis screen was sent. The reports were correlated with previous report. There was leukopenia (from 9,900 to 3,800) and the C-reactive protein (CRP) was positive and the blood culture report showed Salmonella typhi. It was a case of early onset septicemia and responded to cefotaxim. Mother's blood culture report also shows Salmonella typhi.

A 7-day-old baby delivered in peripheral health center by normal vaginal delivery with birth weight of 2.6 kg was admitted in our hospital on day 7 of life with complaints of abnormal posturing, refusal to feed, and jaundice up to thigh. There was a history of feeding the baby with water and mishri (local made sugar cube) a practice of administering sweet water to the newborn babies. The newborn was examined and found to be in shock with tachycardia heart rate (HR) > 190/min, tachypnea respiratory rate (RR) > 70/min. Intravenous (IV) line was put and blood samples for investigation was taken including blood culture keeping sepsis with shock in mind. The newborn was treated with IV fluid 20 ml/kg bolus followed by dopamine drip at 10 mg/kg/min and antibiotic inj. ceftriaxone and inj. amikacin were started. The baby was kept in thermoneutral environment under radiant warmer. The newborn improved with therapy. In the sepsis screen TLC was 4,500, absolute neutrophil count (ANC) 2,350, and CRP positive and blood culture and sensitivity (C/S) was Salmonella typhi positive. It was sensitive to all antibiotics except amoxicillin, augmentin, and cefuroxim. Lumber puncture report showed cerebrospinal fluid (CSF) protein 200 mg, sugar 86 mg/dl, and all three types of lymphocytes. The newborn was continued with antibiotics. This was a case of late onset septicemia with shock.

Salmonella is usually not considered in differential diagnosis of neonatal sepsis. There are reports of vertical transmission from mother to fetus transmission and horizontal transmission from exogenous routes either by fecal contamination of lower birth canal or aspiration or ingestion of contaminated food as top feed or reports of oral suction in nursery leading to sepsis has been reported. [4],[5]

In our case report, the presentations were varied from asymptomatic newborn to shock presentation. This varied presentation makes salmonella a difficult diagnosis in salmonella neonatorum and only high index of suspicion can clinch the diagnosis in endemic areas. Salmonella typhi should be considered in neonatal sepsis in these endemic regions.

 
  References Top

1.Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ 2006;333:78-82.  Back to cited text no. 1
    
2.Kapoor JP, Mohan M, Talwar V, Daral TS, Bhargava SK. Typhoid fever in young children. Indian Pediatr 1985;22:811-3.  Back to cited text no. 2
    
3.Sudhindra BK. Enteric fever in young children. Indian Pediatr 1995;32:1127.  Back to cited text no. 3
    
4.Reed RP, Klugman KP. Neonatal typhoid fever. Pediatr Infect Dis J 1994;13:774-7.  Back to cited text no. 4
    
5.Mukherjee D, Banerjee J. Neonatal salmonella infection. Indian Pediatr 1996;33:438-9.  Back to cited text no. 5
    



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