Dear Editor

We read with interest the article by K. Swe Swe and coauthors (1), which enriches our knowledge about non-typhoidal salmonella meningitis. From our own experience, we know that there are unexpected difficulties in addressing some aspects of this rare disease, which may result in inaccuracies. The authors stated that 10 out of total 17 cases of this rare infection have been reported in adults lacking positive HIV status. Back in 1984, using the English literature of pre-HIV era, Hardy and coauthors also counted 10 reports of adult patients with non-typhoidal salmonella meningitis (2). This was an underestimation due to inaccuracy in the account of Kaufmann and St. Hilaire (3), upon which the authors of both above mentioned papers drew their conclusions. Since 1984 the collection of articles about this condition in English has grown and some of them are cited by Carr and coworkers (4). In addition, more than 10 cases of meningitis caused by Salmonellae in adults have been reported in Spanish and French (5, 6). Currently, the approximate number of cases described in the medical literature appears to be at least twice that provided by the authors. Further, the list of published Salmonella typhimurium meningitis reports in adults, which the authors limited to 3, is also longer (7, 8, 9).

We have stressed previously that accounts regarding recorded salmonella meningitis cases in some frequently cited sources are incorrect (10). When it comes to the description of rare diseases, comprehensive analysis of literature, including older and non-English articles, can add substantially to the accuracy of publication.

Yuri Zagvazdin, Ia Zagvazdina

REFERENCES:

1. Swe KS, Nagel G, Van der Westhuizen M, et al. Salmonella typhimurium meningitis in an adult patient with AIDS. J Clin Pathol 2008; 61:138-9.

2. Hardy C, Bansal A, Lowes JA, et al. Salmonella meningitis following treatment of enteritis with neomycin. Postgrad Med J 1984; 60: 284-6.

3. Kauffman CA, St Hilaire RJ. Salmonella meningitis. Occurrence in an adult. Arch Neurol 1979; 36: 578-80.

4. Carr BG, Weisbein JL, Gaieski DF. Salmonella meningitis in an immunocompetent adult. J Emerg Med 2008 (In press)

5. Tena D, Pérez Pomata MT, Gimeno C, et al. Salmonella sp. meningitis in the adult. Case report and review of the Spanish literature. Enferm Infecc Microbiol Clin 2001; 19: 238-40.

6. Aissaoui Y, Azendour H, Balkhi H, et al. Postoperative meningitis caused by an unusual etiological agent: Salmonella enteritidis. Neurochirurgie 2006; 52: 547-50.

7. Spieckermann D, Lütticken R, Goertz B. Salmonella meningitis in adults: a case of Salmonella typhimurium infection. Infection 1973; 1: 178-80.

8. Korchinskaia TA. Meningeal lesions in salmonellosis. Vrach Delo 1975; 12:126-7.

9. Chhina RS, Gupta BK, Wander GS, et al. Chloramphenicol resistant Salmonella meningitis in adults--a report of 3 cases. J Assoc Physicians India 1993; 41: 535.

10. Zagvazdina Ia, Zagvazdin Y, Willis GE, et al. Rare infections are just an airplane trip away: Salmonella typhi meningitis in a recent immigrant to the United States. Am J Med Sci 2005; 330: 198-200.