CASE PRESENTATION.ppt
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1) A 37-year-old male with lung cancer was admitted with fever, abdominal pain, and constipation and was diagnosed with non-typhoidal Salmonella sepsis based on blood culture results. 2) The isolated Salmonella strains were resistant to nalidixic acid, ciprofloxacin, and ofloxacin. 3) Non-typhoidal Salmonella is a common cause of bloodstream infections worldwide, especially in immunocompromised individuals, and can cause serious complications like acute kidney injury, pneumonia, and death in up to 15% of cases.
CASE PRESENTATION.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 .
- 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
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