Common Tropical Illness Due to Uncommon Species

Madhuri Kadam

Department of Paediatrics, Khurshitji Beharamji Bhabha Municipal General Hospital, Mumbai, Maharashtra, India

Corresponding Author: Madhuri Kadam, Department of Paediatrics, Khurshitji Beharamji Bhabha Municipal General Hospital, Mumbai, Maharashtra, India, Phone: +91 9869032965, e-mail: drmadhurikadam@gmail.com

Received: 05 February 2024; Accepted: 12 March 2024; Published on: 15 May 2024

ABSTRACT

Aim and background: This case report details a rare instance of Salmonella Gallinarum infection in a human with a history of exposure to poultry.

Case description: A 12-year-old boy presented with fever, respiratory symptoms, and leukopenia, diagnosed with Salmonella Gallinarum, likely contracted from contact with poultry. Ceftriaxone and azithromycin were effective, leading to clinical improvement. Family members, especially the child caring for animals, received education on hand hygiene and improved animal care practices to prevent future zoonotic exposures. Follow-up blood cultures confirmed Salmonella Gallinarum clearance.

Conclusion: The case underscores the importance of considering zoonotic sources in febrile illnesses and highlights the role of comprehensive hygiene measures in preventing such infections, especially in households with diverse animal exposure.

Clinical significance: Salmonella Gallinarum infections in humans are rare, and the symptoms are generally consistent with those of salmonellosis caused by other Salmonella serotypes. The infection typically occurs due to close contact with infected birds, particularly poultry.

How to cite this article: Kadam M. Common Tropical Illness Due to Uncommon Species. Pediatr Inf Dis 2024;6(2):57–59.

Source of support: Nil

Conflict of interest: None

Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.

Keywords: Case report, Fowl typhoid, Poultry, Salmonella Gallinarum

INTRODUCTION

Fowl typhoid is a bacterial infection that predominantly affects poultry and other Galliformes birds.¹ The primary causative agent of fowl typhoid is Salmonella enterica Serovar Gallinarum (S. Gallinarum), which is considered the most predominant. Salmonella Gallinarum, a gram-negative rod, is a serotype commonly found in poultry.² Belonging to the Salmonella serogroup D, it is distinguished by its nonflagellated nature and the presence of specific O antigens, namely O antigens 1, 9, and 12.³^,⁴ These antigens play a crucial role in the classification and identification of Salmonella strains. The key characteristics of Salmonella Gallinarum in the context of fowl typhoid include its specific serovar, serogroup, gram-negative nature, and its association with the family Enterobacteriaceae.

Human infections with Salmonella Gallinarum are infrequent, and when they do occur, they are often associated with close contact with infected birds, such as poultry farmers or in close contact with poultry. If a human becomes infected with Salmonella Gallinarum, the symptoms are generally consistent with those of salmonellosis caused by other Salmonella serotypes. These symptoms may include diarrhea, abdominal cramps, fever, nausea, vomiting, and headache. The severity of the illness can vary. In healthy individuals, the infection may be self-limiting and resolve without specific medical treatment. However, in some cases, especially in vulnerable populations such as the elderly, very young, or immunocompromised individuals, severe illness and complications may occur.⁵

Transmission mainly occurs via the fecal-oral route. Self-limiting enteritis is the most frequent manifestation, although other syndromes have been documented. The potential risk these avian strains pose to immunocompromised individuals remains uncertain.⁶ As per the literature search till date there are only very few cases have been reported in humans to date.⁷^-¹⁰ This case report details a rare instance of Salmonella Gallinarum infection in a human with a history of exposure to poultry.

CASE DESCRIPTION

A 12-year-old healthy boy with a body mass index of 21.7 presented with a 5-day history of high fever (T_max of 104°F), chills, nausea, vomiting, and a mild cough. There were no symptoms related to the bowel or bladder. He had been taking suboptimal doses of oral amoxicillin and clavulanic acid for 3 days to address the fever and respiratory symptoms. Clinical examination revealed hemodynamic stability, with no apparent focus on infection or organ enlargement. The child had received immunizations up to date till 5 years of age, including the typhoid vaccine.

The patient was investigated for common tropical illnesses, and ceftriaxone was initiated after sending blood cultures. Blood tests indicated leukopenia and the typhoid test was positive. Tests for COVID-19, dengue, and malaria were negative, and urine analysis showed no abnormalities. After developing a rash following a single dose of ceftriaxone, the patient was switched to intravenous piperacillin–tazobactam at a dosage of 100 mg/kg/dose every 8 hours for 5 days, followed by 5 days of oral cefixime at a dosage of 20 mg/kg/day, with azithromycin added on day 3 due to a positive Widal test and persistent fever. By 4–5 days, the fever and other accompanying symptoms began to show improvement.

Blood culture results revealed the growth of Salmonella Gallinarum, which was sensitive to cephalosporins. The complete blood count results revealed hemoglobin levels of 12.8 gm/dL, a white blood cell count of 3,800 cells/mm³ with 60% neutrophils and 36% lymphocytes, and a platelet count of 169,000/mm³. The C-reactive protein level was elevated at 70 mg/L. Liver function tests indicated serum glutamic-pyruvic transaminase levels of 69 U/L and serum glutamic-oxaloacetic transaminase levels of 84 U/L. Additionally, albumin levels were measured at 2.7 gm/dL, while creatinine levels were within normal limits at 0.9 mg/dL. Considering the uncommon nature of this Salmonella species, a detailed history revealed that the family had various animals, including hens, and the child actively cared for all of these animals, including feeding them. Possibly, the boy acquired the infection through contact with poultry.

In the follow-up of the patient, after initiating the appropriate antibiotic treatment, there was notable improvement in the clinical condition. The patient’s fever subsided, and other symptoms such as chills, nausea, vomiting, and cough showed significant resolution. Additionally, further investigations, including blood cultures, were performed to confirm the clearance of the Salmonella Gallinarum infection. A follow-up blood culture was conducted after 3 days to assess for persistent bacteremia, and the results were negative.

Given the zoonotic nature of Salmonella Gallinarum and the family’s involvement with various animals, recommendations for improved hygiene practices and animal care were provided to prevent potential future exposures. Family members were educated, particularly the child who actively cares for the animals, about the significance of hand hygiene in preventing the transmission of potential pathogens.

DISCUSSION

This rare case of a Salmonella Gallinarum infection in humans underscores the importance of vigilance in understanding and managing zoonotic infections. Reviewing the literature on Salmonella Gallinarum infection in humans reveals a limited number of documented cases. The available studies predominantly highlight instances where individuals have contracted this particular Salmonella serotype, often associated with close contact with infected poultry. The literature underscores the rarity of such human infections and emphasizes the significance of exposure to birds, especially in occupations like poultry farming. Clinical presentation varies from typhoid-like illness and urinary tract infection to septicemia in humans. Prevention of human infections involves implementing measures to reduce the risk of exposure to contaminated poultry or their environments.¹¹^,¹²

The presented case underscores several key points relevant to the diagnosis, management, and prevention of Salmonella Gallinarum infection, particularly in pediatric patients. The patient exhibited typical symptoms of typhoid fever, including high fever, chills, nausea, vomiting, and a mild cough. These symptoms, along with a positive typhoid test and leukopenia, raised suspicion of a typhoid fever-like illness. However, the identification of Salmonella Gallinarum through blood culture highlighted the importance of considering atypical Salmonella serovars, especially in regions where poultry exposure is common.

Salmonella Gallinarum infections in humans are rare and typically occur due to close contact with infected birds, particularly among poultry farmers. When humans do contract Salmonella Gallinarum, the symptoms resemble those of salmonellosis caused by other Salmonella serotypes, including diarrhea, abdominal cramps, fever, nausea, vomiting, and headache. The severity of the illness varies among individuals.¹³^-¹⁵

Given the relatively infrequent occurrence of Salmonella Gallinarum infections in humans, the need for continued research is emphasized and vigilance to better understand the epidemiology, clinical characteristics, and preventive strategies associated with this particular Salmonella serotype. Vigilance is crucial for early identification of rare cases, allowing for prompt intervention and prevention of potential outbreaks. This involves active surveillance of both human and animal populations. Preventing human infections involves implementing measures to reduce the risk of exposure to contaminated poultry or their environments.

CONCLUSION

Salmonella Gallinarum infections in humans are rare, and the symptoms are generally consistent with those of salmonellosis caused by other Salmonella serotypes. The infection typically occurs due to close contact with infected birds, particularly poultry.

Clinical Significance

Awareness about the possible diagnosis of Salmonella Gallinarum infection, especially for those working with poultry, is required among healthcare professionals.

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