Salmonella spp. Meningitis: A Case Report

Abstract

Background: Salmonella spp. meningitis is an uncommon but potentially severe infection in infants. It is associated with a high risk of neurological complications, relapse and prolonged antimicrobial treatment. Because of its rarity, the optimal duration and combination of antimicrobial therapy remain uncertain, and management is usually guided by clinical response, cerebrospinal fluid findings, microbiological results and available case-based evidence. Case Presentation: We report the case of a 4-month-old male infant admitted with fever, irritability, anorexia, inconsolable crying, asthenia, adynamia and bulging of the anterior fontanelle. Initial laboratory evaluation showed inflammatory markers, and cerebrospinal fluid analysis demonstrated pleocytosis, elevated protein and findings consistent with bacterial meningitis. Cerebrospinal fluid culture subsequently grew Salmonella spp., which was reported as susceptible to ceftriaxone, meropenem, trimethoprim/sulfamethoxazole and ampicillin. Initial treatment included ceftriaxone and dexamethasone. Because of clinical deterioration with recurrent fever, irritability and persistent abnormal cerebrospinal fluid findings, antibiotic therapy was changed to meropenem. Ciprofloxacin was later added after further cerebrospinal fluid evaluation. Neuroimaging during admission showed increased subarachnoid spaces and later generalised cortico-subcortical atrophy with ventriculomegaly and hypomyelination of white matter. The patient completed 9 days of ceftriaxone, 42 days of meropenem and 14 days of ciprofloxacin, and was discharged after 53 days of hospitalisation. Conclusion: At 6-month follow-up after discharge, the child had no clinically evident neurological events and showed age-appropriate neurodevelopment. This case highlights the importance of early recognition, microbiological confirmation, repeated cerebrospinal fluid evaluation, prolonged antimicrobial treatment and close neurological follow-up in infants with Salmonella spp. meningitis.