A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient

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dc.contributor.author Rule, Roxanne
dc.contributor.author Mbelle, Nontombi Marylucy
dc.contributor.author Osei Sekyere, John
dc.contributor.author Kock, Marleen M.
dc.contributor.author Said, H.M. (Halima Mohammed)
dc.date.accessioned 2020-07-10T12:01:02Z
dc.date.available 2020-07-10T12:01:02Z
dc.date.issued 2019-09-14
dc.description Additional file 1: Annotation results of S. Enteritidis strain EC20120916 genome. MLST, pathogenicity island, plasmid typing, resistance gene and pathogenicity of the strain determined to be ST11, five (C63PI, SPI-5, SPI- 13, SPI-3, SPI-14), IncFII(S) and IncFIB(S), 0.94, and aac (6′)-Iaa respectively. en_ZA
dc.description Additional file 2: Metadata of isolates used for phylogenetic tree Fig. en_ZA
dc.description Additional file 3: Metadata of isolates used for phylogenetic tree Fig. 2B en_ZA
dc.description.abstract BACKGROUND : Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive isolate such as cerebrospinal fluid (CSF). Colistin resistance has important infection control implications and failure to manage this phenomenon may lead to the loss of our last line of defence against multi-drug resistant Gram-negative organisms. To our knowledge, this is the first reported clinical case of colistin-resistant Salmonella Enteritidis meningitis in South Africa. CASE PRESENTATION : We report a case of a young male patient with advanced human immunodeficiency virus (HIV) infection who presented to hospital with symptoms of meningitis. Cerebrospinal fluid (CSF) cultured a Salmonella Enteritidis strain. Antimicrobial susceptibility testing (AST) of the isolate, revealed the strain to be colistin resistant. Despite early and aggressive antimicrobial therapy, the patient succumbed to the illness after a short stay in hospital. Subsequent genomic analysis of the isolate showed no presence of the mcr genes or resistance-conferring mutations in phoPQ, pmrAB, pmrHFIJKLME/arnBCADTEF, mgrB, and acrAB genes, suggesting the presence of a novel colistin resistance mechanism. CONCLUSION : Invasive non-typhoidal salmonellae infection should be suspected in patients with advanced immunosuppression who present with clinical features of meningitis. Despite early and appropriate empiric therapy, these infections are commonly associated with adverse outcomes to the patient. Combination therapy with two active anti-Salmonella agents may be a consideration in the future to overcome the high mortality associated with NTS meningitis. Colistin resistance in clinical Salmonella isolates, although a rare finding at present, has significant public health and infection control implications. The causative mechanism of resistance should be sought in all cases. en_ZA
dc.description.department Medical Microbiology en_ZA
dc.description.librarian am2020 en_ZA
dc.description.sponsorship The National Health Laboratory Services (Grant No.: 94445) and the University of Pretoria (Grant No.: A0702). en_ZA
dc.description.uri https://bmcinfectdis.biomedcentral.com en_ZA
dc.identifier.citation Rule, R., Mbelle, N., Sekyere, J.O. et al. 2019, 'A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient', BMC Infectious Diseases, vol. 19, art. 806, pp. 1-7. en_ZA
dc.identifier.issn 1471-2334 (online)
dc.identifier.other 10.1186/s12879-019-4391-7
dc.identifier.uri http://hdl.handle.net/2263/75123
dc.language.iso en en_ZA
dc.publisher BioMed Central en_ZA
dc.rights © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. en_ZA
dc.subject Salmonella Enteritidis en_ZA
dc.subject Meningitis en_ZA
dc.subject Colistin resistance en_ZA
dc.subject Human immunodeficiency virus (HIV) en_ZA
dc.subject Non-typhoidal salmonellae (NTS) en_ZA
dc.subject Cerebrospinal fluid (CSF) en_ZA
dc.subject South Africa (SA) en_ZA
dc.subject Antimicrobial susceptibility testing (AST) en_ZA
dc.title A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient en_ZA
dc.type Article en_ZA


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