Salmonella Typhimurium meningitis in an adult AIDS patient

Abstract

Salmonella meningitis is an unusual complication of Salmonella sepsis and occurs mainly in children. We report a rare case of Salmonella Typhimurium meningitis occurring in a 40 year old HIV positive male who presented with a history of fever and diarrhoea. On examination he was dehydrated, had oral thrush, weakness of lower limbs and neck stiffness. A septic diagnostic screen was performed and he was commenced on empiric intra-venous cefotaxime therapy for meningitis. The cerebro-spinal fluid (CSF) revealed high protein, low glucose, low chloride and S Typhimurium cultured from the CSF and blood culture specimens. It was non-lactose fermenting, oxidase negative, H2S positive and motile. It was identified as Salmonella Typhimurium confirmed by the National Institute of Communicable Diseases (NICD) S.A. The isolate was susceptible to cefuroxime, cefotaxime, ceftriaxone, ciprofloxacin, and chloramphenicol but resistant to ampicillin and cotrimoxazole. Cefotaxime was continued for 14 days and the patient responded without neurological sequelae even with a low CD4 count 2x106/L, and was discharged to a hospice for continued care.