Salmonella meningitis and its complications in infants

Objective: To review the presenting features, complications and outcome of infants with Salmonella meningitis. Methodology: Retrospective review of all cultures of cerebrospinal fluid po sitive for bacteria in children below 12 years of age, processed at the Dep artment of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur from 1973 to 1997. Records of all cases positive for Salmonella spe cies were retrieved and studied. Results: Thirteen infants aged 3 days to 9 months with Salmonella meningiti s were included. The median age of onset of symptoms was 4 months. The clin ical and laboratory features were similar to other causes of bacterial meni ngitis. Salmonella enteritidis was the commonest serotype isolated. Nine in fants developed fits, six of which were difficult to control. Other complic ations noted were hydrocephalus (five), subdural effusions (four), empyema (three), ventriculitis (two), intracranial haemorrhage and cerebral abscess (one each). The use of ampicillin and/or chloramphenicol and inadequate du ration of therapy resulted in recrudescence or relapse in five infants. The overall mortality was 18%. The presence of empyema, intracerebral abscess, ventriculitis, hydrocephalus, and intracranial haemorrhage were associated with adverse neurodevelopmental sequelae or death. More than half of those who survived had normal long-term outcome. Conclusions: Infants who developed neurological complications as a result o f Salmonella meningitis had significant mortality and adverse long-term neu rodevelopment outcome.