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LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 3  |  Page : 180

Neonatal septicemia caused by Salmonella paratyphi a in two nonbreast fed babies: Report from a rural teaching hospital in India


Department of Pediatrics, MMIMSR, Mullana, Ambala, Haryana, India

Date of Web Publication8-Sep-2014

Correspondence Address:
Dr. Baljeet Maini
House No. 482, Housing Board Colony, Sector- 4, Karnal - 132 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.140422

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How to cite this article:
Maini B, Bansal R, Madaan G. Neonatal septicemia caused by Salmonella paratyphi a in two nonbreast fed babies: Report from a rural teaching hospital in India. J Clin Neonatol 2014;3:180

How to cite this URL:
Maini B, Bansal R, Madaan G. Neonatal septicemia caused by Salmonella paratyphi a in two nonbreast fed babies: Report from a rural teaching hospital in India. J Clin Neonatol [serial online] 2014 [cited 2021 Sep 17];3:180. Available from: https://www.jcnonweb.com/text.asp?2014/3/3/180/140422

Sir,

Top feeding and partial breast feeding increase the incidence of mortality and morbidity in the newborns substantially, as proven in a recent study from an African country Ghana. [1] The bacteriological profiles of neonatal sepsis mention Salmonella as a rare causative agent. [2] In recent years, few reports of Salmonella as the causative pathogen in sepsis in newborns in India have attempted to highlight its importance in endemic country like India. [3],[4] The possible routes of acquiring neonatal salmonellosis are by vertical (mother to fetus) transmission or an exogenous source like top feeds. [5] A high gastric pH increases the susceptibility for Salmonella colonization in exposed newborns. [5] Salmonella paratyphi A is even more rarely implicated in neonatal septicemia. [2],[3] We treated two nonbreast fed babies for late onset neonatal septicemia (LONS) in whom S. paratyphi A was the causative organism. In both of our cases, entire laboratory work up of mothers was negative for Salmonella infection.

First baby was a 2-week-old male admitted with the complaints of fever, poor feeding and loose motions. There was history of being totally fed with diluted cow milk since day 5 of life. A provisional diagnosis of LONS was made and was treated as per nursery protocol of our hospital. Blood culture grew S. paratyphi A sensitive to piperacillin-tazobactum and amikacin. Antibiotics were given in accordance to culture report and were administered for a total of 14 days as cerebrospinal fluid (CSF) culture was sterile. There was clinical improvement and soon the baby was on full feeds by day 3 of treatment. Breast feeding was re-established successfully gradually. Final diagnosis was S. paratyphi A LONS without meningitis. Second patient was a 10-day-old baby admitted with complaints of fever, poor feeding for 2 days prior. Baby was born vaginally as term healthy appropriate for age male in a private health facility. There was history of being totally fed with diluted cow milk since day 2 of life. A provisional diagnosis of late onset septicemia was made and baby was treated as per nursery protocol. CSF biochemical analysis was suggestive of meningitis. Blood and CSF culture grew S. paratyphi A sensitive to piperacillin-tazobactum, ceftriaxone and amikacin. Antibiotics were changed in accordance to culture report. Final diagnosis was S. paratyphi A LONS with meningitis. Soon, there was improvement and the baby was started on feeding by spoon. Baby was shifted to mother's cot by day 3 of admission. Baby was discharged after 21 days of antibiotic completion. In follow-up visit, both babies are currently doing fine and all growth and development parameters are normal at age of 7 months.

These two cases clearly demonstrate that in India, we should strongly keep infection with Salmonella as a possibility in all neonates who are top fed and present with infection. We need to promote breast feeding in India, more and more, to prevent the infection and consequent devastating sequelae.

 
  References Top

1.Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early infant feeding practices on infection-specific neonatal mortality: An investigation of the causal links with observational data from rural Ghana. Am J Clin Nutr 2007;86:1126-31.  Back to cited text no. 1
    
2.Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J 2009;28 1 Suppl: S10-8.  Back to cited text no. 2
    
3.Mohanty S, Gaind R, Sehgal R, Chellani H, Deb M. Neonatal sepsis due to Salmonella typhi and paratyphi A. J Infect Dev Ctries 2009;3:633-8.  Back to cited text no. 3
    
4.Singhal V, Ek S, Sm R, Coutinho A. Neonatal Salmonella typhi meningitis: A rare entity. J Clin Diagn Res 2012;6:1433-4.  Back to cited text no. 4
    
5.Reed RP, Klugman KP. Neonatal typhoid fever. Pediatr Infect Dis J 1994;13:774-7.  Back to cited text no. 5
    



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