CASE PPT

1. Case presentation on non typhoidal salmonella sepsis in
carcinoma lung patient
Dr. Ajit Kumar Singh
PGT-Laboratory medicine
CNCI , Kolkata-700160
Moderator
Dr. Subhranshu Mandal , MD
Associate professor
Department of laboratory medicine
Chittaranjan National Cancer Institute, Kolkata

2. ■ A 37 years old male with known case of PNET right lung , right lung
upper lobectomy done 2014 . Treatment consists of 6 cycles of
chemotherapy with etoposide, ifosfamide - mesna , lost f/up since
10/11/2014.
■ Patient admitted for supportive care and planned for palliative RT
(20GY /5 fractions).
■ CT SIM(simulator) done on 16/6/23 .
■ To start with Cap. TEMOZOLAMIDE 250MG OD (D1 TO D5 From
30/06/2023 to 04/07/2023).
■ On date 03/07/2023 Patient complains of pain abdomen , back pain ,
and constipation .
■ O/E (12:53 pm ) – fever 1010F , BP 60/40 , HR 140/ minutes .

3. Physician advice

4. ■ Sample received (date & time) – 03/07/2023 01:53 pm .
■ Samples were directly inoculated in Bactalert culture bottles.
■ Two sets of blood samples (10 mL each) were taken from separate sites.
■ BacT/Alert automated microbial detection system uses an internal colorimetric
sensor that changes from gray to yellow in the presence of CO 2 produced by
growing micro-organisms and utilizes active carbon to remove antibiotics from
blood samples.

5. 04/07/202
3
 BACT /ALERT automated
microbial detection system
shows positive result after
18-24 hrs of inoculation. .

6. Sub culture and Gram stain (04/07/2023)
■ Later on, sub culture was done on Mac Conkey and Blood Agar
■ Aerobic condition , Incubated at 37.80C for 18–24 h .
■ Gram staining - Gram Negative straight rods like organism are seen.

7. Identification and AST (05/07/2023)
■ Aerobic conditions at 37°C colonies are gray and non- hemolytic on blood agar plates
and non lactose fermenting on MacConkey agar.
■ Subsequently, non-lactose fermenting colonies were processed for identification ,
antibiotic sensitivity and MIC value with the help of Vitek2 (Biomerieux System).
■ Antimicrobial susceptibility testing was done in accordance with Clinical and Laboratory
Standards Institute (CLSI).
■ Antibiotics discs for azithromycin & chloramphenicol , by Kirby–Bauer's disc diffusion
method,
■ Vitek2 gave results of nearly all relevant antibiotics.
■ Ampicillin , Ceftriaxone , Nalidixic acid , Ciprofloxacin , Cotrimoxazole , Cefixime and
Ofloxacin.

9. 06/07/2023

12. ■ Drug resistance in Non-typhoidal Salmonella ( NTS) is considered one of the
important factors in the morbidity and mortality from the disease.
■ Ampicillin, chloramphenicol and ciprofloxacin have been the main drugs used for
treatment.
■ Isolated strains were resistant to nalidixic acid (nalidixic acid-resistant Salmonella
spp).
■ Isolated stains were resistant to ciprofloxacin and ofloxacin(FQ).
■ Hence ciprofloxacin can no be considered to be the keystone for treatment.

13. Epidemiology
■ World wide distribution
■ Related to animal husbandry : ZOONOTIC
■ Most common :
■ S. enteritidis & S. typhimurium
■ India : endemic

14. Route of transmission
■ Feaco-oral – direct or indirect
■ Contaminated poultry , pork , beef ,infected egg. .
■ Fecal contamination of water

15. Risk factor
■ Immunocompromised conditions
■ HIV
■ Malignancy
■ Long term steroids
■ DM
■ Malnutrition in children
■ Reticuloendothelial blocked e.g malaria , scd , etc

16. Clinical presentation of NST
■ Acute gastroenteritis (m/c)
■ Non bloody diarrhea , N/V .
■ Fever ,
■ Abdominal cramp
■ Asymptomatic carriage can occur in about 5% of healthy hosts.

17. Diagnosis
■ Culture : Gold standard
■ Stool , blood cultures
■ Automated ID system (VITEK) : ONLY GIVE SALMONELLA SP.
■ Final diagnosis : By reference laboratory.

18. Treatment guidelines
■ In contrast to enteric fever where antibiotics started as early as possible, in
uncomplicated case NTS Gastroenteritis , the treatment is conservative with fluid
replacement.
■ Antibiotic use in NTS :
■ CIPROFLOXACIN
■ CEFTRIAXONE is indicated for bacteremia and invasive infection.

19. ■ New variant : typhimurium ST 313
■ CFT : 20-25 %
■ Relapse : defenitely relapse
■ 17% - 60 %
■ Carrier :

20. Our case
■ Treated for 2 weeks
■ Prevention and control:
■ Education and no vaccine
■ Our experience
■ Treated for 2 weeks – no mortality.
■ Discharge date : 07/07/2023.
■ Follow up visit : 19/07/23

21. Non-typhoidal Salmonella blood stream infection in
Kuwait : Clinical and microbiological characteristics
M. John AlbertI Dieter Bulach , Wadha Alfouzan, Hidemasa Izumiya, Glen Carter, Khaled Alobaid , Fatemah Alatar , Abdul Rashid Sheikh ,
Laurent Poirel.
Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
 In two tertiary hospitals–Al Farwaniya and Al Amiri–in Kuwait,
a subtropical country, from April 2013-May 2016. NTS
bacteremia was present in 30 of 53,860 (0.75%) and 31 of
290,36 (1.33%) blood cultures in the two hospitals respectively.
 Patients were either young or old. Most of the patients had co-
morbidities affecting the immune system.
 Apart from causing other infections, NTS causes blood-stream
infection (bacteremia and septicemia).

22. Time to positivity in blood cultures of adults
with nontyphoidal Salmonella bacteremia
Hui-Wen Lin , Hsin- Sui Hsu , Yu-Tsung Huang , Chia-Jui Yang , Meng-Shiuan Hsu ,Chun- Hsing
Liao
Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital,
New Taipei City, Taiwan AND School of Medicine, National Yang Ming University, Taipei, Taiwan
■ The median TTP was 11.5 hours
■ Range 6.5 – 41.7 hours( mean 13.7 , standard deviation 7.0 hours)
■ Rapid time of positivity is associated with greater mortality.

23. Complications and mortality of non-typhoidal salmonella
invasive disease: a global systematic review and meta-
analysis
Christian S Marchello, Megan Birkhold, John A Crump, on behalf of the Vacc-iNTS consortium
collaborators.
■ Typhimurium and Enteritidis, have been identified as the most common causes of
non-typhoidal salmonella invasive disease in humans.
■ Non-typhoidal salmonella invasive disease was deadly, with a pooled CFR estimate
of 14·7%.
■ The CFR of non-typhoidal salmonella invasive disease is markedly higher than that
estimated for other major febrile illnesses, such as malaria, with an estimated CFR
of 0·2%, and typhoid fever, with an estimated CFR of 2·0%.

24. high prevalence of serious complications among patients with non-typhoidal
salmonella invasive disease, including :
■ Acute kidney injury
■ Encephalopathy
■ Pneumonia
■ Haemorrhage , and mycotic aneurysm.
■ Other less prevalent, but serious, life-threatening complications identified included
:
■ pancreatitis,
■ encephalitis,
■ meningitis,
■ myocarditis, and colonic perforation

25. Thank you…