SALMONELLA MYOCARDITIS. REPORT OF A CASE WITH VENTRICULAR RUPTURE

Salmonella typhimurium myopericarditis: A case report and review of literature

BACKGROUND

Non-typhoidal salmonella (NTS) is a rare, but well-established cause of myopericarditis. Presenting symptoms may be varied, however often revolve around the dual presentation of both myopericarditis and infectious diarrhoea. Given the rarity of NTS related myopericarditis, we conducted a systematic review of the literature, identifying 41 previously reported cases.

CASE SUMMARY

We present the case of an otherwise healthy 39-year old male, presenting with chest pain in the setting of documented Salmonella typhimurium infection. After further investigation with echocardiogram and laboratory blood tests, a diagnosis of NTS associated myopericarditis was made, and the patient received antibiotic treatment with an excellent clinical outcome. Overall, myopericarditis is rare in NTS. Although treatment for myopericarditis has not been well established, there are guidelines for the treatment of NTS infection. In our review, we found that the majority of NTS cases has been pericarditis (27/42, 64.3%), with an average age of 48.3 years, and 71.4% being male. The average mortality across all cases was 31%.

CONCLUSION

Myopericarditis is a rare, but potentially serious complication of NTS infection, associated with an increased morbidity and mortality.

Pericardial salmonella with cardiac tamponade and ventricular wall rupture: A case report

Introduction

Non-typhoidal Salmonella (NTS) is mostly restricted to gastroenteritis; however, we report a case of Salmonella pericarditis complicated by tamponade and spontaneous ventricular wall rupture.

Case presentation

A 67-year-old male presents to the Emergency Department with complaints of fevers, chills and body aches. A chest radiograph displayed an infiltrate and an electrocardiogram suggested acute pericarditis. An echocardiogram revealed a small pericardial effusion without tamponade. Broad-spectrum antibiotics were initiated until Salmonella was discovered in blood cultures. The hospital course was complicated by sudden decompensation, and a repeat echocardiogram displayed a large effusion with constrictive physiology. During a pericardial window, the tissue was noted to have a thickened appearance with a complex effusion. The following day, the patient developed increased chest tube drainage, hypotension and acidosis, requiring an emergent sternotomy. The right ventricle was friable and had spontaneously ruptured. After ventricular repair and pericardiectomy, the tissue was sent for cultures and pathology. The specimen revealed Salmonella enteriditis. Treatment with ceftriaxone and ciprofloxacin was initiated. On postoperative day four, the patient was successfully extubated. Repeat blood cultures were negative.

Discussion

In our review of literature, only 19 cases of NTS pericarditis have been reported. Prior to our case, salmonellosis resulting in ventricular rupture has been reported once. Early diagnosis and treatment is crucial in minimizing morbidity and mortality. Clinical suspicion based on electrocardiogram and hemodynamic assessment is critical in suspecting pericardial effusion in a patient with nonspecific symptoms and Salmonella bacteremia. The key to recovery involves aggressive treatment, including pericardiectomy and antibiotic treatment.

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Patient with Salmonella pericarditis complicated by tamponade and ventricle rupture.

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Salmonella enteriditis bacteremia secondary to a cardiac source.

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Promptly diagnose and treat patients with hemodynamic compromise from tamponade.

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Consider a cardiac etiology when faced with Salmonella bacteremia.

Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis

AIM: To study trends in the epidemiology, clinical presentation, microbiology and prognosis of non-typhoid Salmonella (NTS) myocarditis.

METHODS: We performed a systematic literature search for all reported NTS cases. The search yielded 838 publications. A total of 21 papers were deemed eligible. No language restrictions were enforced. Articles that were not written in English were translated. Pre-specified data such as clinical presentation, electrocardiogram (ECG) changes, transthoracic echocardiographic findings, cardiac magnetic resonance findings, microbiology cultures, Salmonella species, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), cardiac biomarkers and severity of illness were collected using data extraction sheets. Cases were classified by age into 2 groups; pediatric cases (defined as < 18 years old) and adult cases (defined ≥ 18 years old). The mean age of patients and standard deviations were calculated. The data was analyzed with IBM SPSS Statistics (Windows, Version 20.0. Armonk, NY: IBM Corp.) for demographic characteristics, presenting symptoms, microbiology, diagnostic methods, treatment modalities and outcome.

RESULTS: From the selected articles, we identified a total of 24 individual cases with verifiable data. There were 20 males with a male to female ratio of 5:1. The mean age at presentation was 30.8 years (range 1 mo-67 years), 16% of cases were children aged < 18 years. Most patients presented with chest pain, fever, and abdominal pain. The most common ECG finding was ST elevation. Cardiac biomarkers were elevated in around 70% of cases. Salmonella Enteritidis was the most common NTS isolated. Definitive diagnosis was established by blood and stool cultures in most of the cases. The pediatric and adults cases had similar incidence of bacteremia (40% vs 36.8%) while the pediatric group had more stool cultures positive compared to the adult group (100% vs 63.1%). Eighty-three percent of patients received antibiotics and 58% were successfully treated through conservative management. The overall mortality was 24% and 42% of patients required intensive care.

CONCLUSION: This systematic review of published cases shows that NTS myocarditis occurs predominantly in young adults and carries a poor prognosis.

Salmonella enteritidis induced myocarditis in a 16-year-old girl

Myocarditis typically presents with non-specific clinical symptoms, and can easily be missed in the absence of a high index of clinical suspicion. Myocarditis caused by bacterial pathogens is rare in immunocompetent individuals, more commonly seen following viral infection. Although more classically associated with typhoid fever and gastroenteritis, Salmonella species are a rare cause of myocarditis. We report a case of Salmonella enteritidis-induced myocarditis after gastrointestinal infection in a 16 year-old girl, and discuss the diagnostic tools currently utilised to ascertain the diagnosis.

Salmonella enteritidis Infection Complicated by Acute Myocarditis: A Case Report and Review of the Literature

Salmonella spp. is the cause of commonly encountered infections, with seasonal pattern of occurrence and worldwide distribution. Some of the clinical manifestations such as gastroenteritis and bacteremia are common, whereas others like mycotic aneurysms and osteomyelitis are infrequent especially in immunocompetent patients. Salmonella has been rarely described as a cause of myocarditis in the literature. We describe a case of an 18-year-old previously healthy male patient with myocarditis after Salmonella enteritidis infection. Clinical manifestations and diagnostic approach of this severe complication are discussed with a review of the literature.

Carditis and arthritis associated with Campylobacter jejuni infection

Three patients who developed carditis after enteritis caused by Campylobacter jejuni are reported. Two had perimyocarditis and one endocarditis. The cardiac sequelae persisted in two patients. Concomitant arthritis appeared in two of these patients, monoarthritis in one and polyarthritis in the other.

False aneurysm formation after Salmonella virchow infection of a pre-existent ventricular aneurysm--survival after surgical resection

A 55 year old man with a left ventricular aneurysm, secondary to a previous myocardial infarction, was hospitalized due to a Salmonella virchow bacteraemia. During a 3-week hospital course he was persistently bacteraemic and febrile despite antibiotic treatment. Gallium isotope scanning and 2-D-echocardiography were helpful in demonstrating the presence of an infected false aneurysm at the site of a true aneurysm. Surgical resection in addition to prolonged antibiotic therapy was necessary for cure.

Shigella sonnei myocarditis

A 19-year-old male was admitted to our department because of high fever, abdominal pain, and diarrhea. Electrocardiogram (ECG) on admission revealed diffuse ST-T changes which persisted for 5 days. Stool culture grew Shigella sonnei. We conclude that the infection with Shigella sonnei was the cause for these findings which were most probably due to myocarditis. To the best of our knowledge myocarditis as a complication of shigella infestation has never been reported.

Salmonella endocarditis: successful treatment with parenteral ampicillin and oral amoxicillin

We describe a case of Salmonella typhimurium endocarditis involving the mitral valve secondary to infection with Salmonella typhimurium. The presence of the infective agent was confirmed by blood cultures and the endocarditic lesions by cross-sectional echocardiography. Successful therapy was achieved with parenteral ampicillin and amoxicillin.

Cardiovascular complications of enteric fever

A case of a young female having salmonella typhi infection with cardiovascular complications in the form of myocarditis and femoral artery occlusion is reported. The relevant literature on the subject is reviewed, and possible mechanisms discussed.

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: I. Clinical findings

Stool samples from 775 patients with diarrhoea referred to a hospital over an 18-month period were cultured for Campylobacter fetus ssp. jejuni, and in 55 patients (7.1%), infections were identified. In addition, one asymptomatic patient had a positive stool sample and serological evidence of a current infection. The patients were aged between 11 and 76 years, the majority being in the age group 15 to 39 years. The symptoms included diarrhoea (in almost 100%), fever (in 80%) and abdominal tenderness (in 35%). Almost half the patients vomited. The total leucocyte count was usually normal, but half the patients showed increased numbers of juvenile neutrophils. Eosinopenia and high serum C-reactive protein were frequently seen in the acute phase of the illness. Complications included haematemesis, pancreatic affection, carditis, reactive arthritis, urticaria, and transient malabsorption in one patient who had had a previous Billroth II operation. Invasive disease was occasionally suggested by clinical manifestations of extensive mesenteric lymphadenitis, septicaemia and focal bone necrosis.

Pseudoaneurysm of the left ventricle complicated by Salmonella typhimurium infection. Recognition by two-dimensional echocardiography

A patient is described with a large posterior left ventricular pseudoaneurysm complicated by Salmonella typhimurium infection. M-mode echocardiography displayed a massive echo-free space behind the posterior left ventricular wall, and two-dimensional echocardiography specifically defined the orifice and saccular contour of the false aneurysm. These findings were confirmed by cardiac catheterization and surgery. The unusual features of Salmonella endovascular infection and the noninvasive methods to detect left ventricular pseudoaneurysms are reviewed.

Salmonella typhimurium pancarditis

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