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Presentation

A 2-year-old male presented to the Emergency Department with fever, diarrhea, myalgia, rhinorrhea, dehydration, and decreased activity.  The patient had a past medical history of a heart transplant and post-traumatic lymphoproliferative disorder.  He lived with 3 other siblings, one who was sick with similar diarrheal symptoms.

Lab Testing

A stool specimen was collected specifically for bacteriology culture and sent to the Microbiology laboratory for testing. The specimen was plated on a Blood Agar Plate (BAP), MacConkey Agar Plate (MAC), Hektoen Enteric (HE) agar plate, and a Campy Blood agar plate.  Plated media was observed for the presence of stool pathogens and presumptive colonies were analyzed using standard biochemical testing and the bioMerieux API 20E.  Antibody-based serogrouping reagents were used as indicated.  Black colonies grew on the HE agar media. 

Cause of Symptoms

Biochemical tests indicated the organism was Salmonella species.  Further Wellcolex serogrouping was performed and it was determined that the isolate was a Salmonella enterica subspecies enterica serogroup B.  The local public health department confirmed the organism to be Salmonella enterica subspecies enterica serotype Heidelberg (which was part of a larger United States outbreak at the time). 

Treatment

Patient was initially discharged without antibiotics for presumed viral enteritis.  Treatment for Salmonella gastroenteritis can vary.  Most patients are given oral or intravenous rehydration.  Generally, antibiotics are not recommended because it does not typically shorten the length of illness, and can promote the development of unnecessary resistant strains and prolong the excretion of the organism in the stool.  In high risk groups (underlying medical history, young children, disseminated infection) antibiotics are recommended.  Treatment consists of the following antibiotics: fluoroquinolones, azithromycin, and trimethoprim-sulfamethoxazole. Given the patients’ age and medical history, antibiotics were given after the patient went home from the emergency department.

Contact Information

Nicole Jackson, njackson@asmusa.org