Objective:

NA

Background:

Group D Salmonella is a non-typhoid serotype of Salmonella (NTS), which can cause an array of infections including meningoencephalitis, though it is rare accounting for <1% of bacterial meningitis in neonates. This infection is even more rare in non-endemic regions and in those who are immunocompetent.

Design/Methods:

NA

Results:

An immunocompetent 6-day-old male neonate born at 37 weeks via vaginal delivery without known pregnancy or delivery complications, presented with poor feeding, jaundice in addition to episodes of apnea and respiratory failure requiring intubation. Blood and CSF cultures grew Salmonella group D of presumed vertical transmission at birth and patient was initiated on a protracted course of ceftazidime. Continuous EEG showed multiple electrographic seizures from the right temporo-parieto-occipital region with diffuse background slowing which prompted emergent neuroimaging. Head ultrasound revealed a large presumed venous hemorrhagic infarction in the right posterior cerebral hemisphere with notable mass effect. Seizures were refractory to initial treatment of phenobarbital, fosphenytoin, levetiracetam and midazolam infusion requiring escalation of treatment to include lacosamide, clobazam, and ultimately ketamine infusion for secondary neuroprotection. Sequential MRI studies later showed abscess cavitation within the hemorrhagic-ischemic lesion, requiring craniotomy and repeated drainage. His hospital course was further complicated by secondary obstructive hydrocephalus from ventriculitis with increased ICP, he underwent an endoscopic third ventriculostomy (ETV). Prior to discharge at 3 months of age he tolerated a wean of phenobarbital without recurrence of seizures on EEG. His discharge exam was significant for central hypotonia and mild left-sided extremity spasticity while breathing on room air and feeding orally.

Conclusions:

NTS meningitis, is a rare yet severe CNS infection with a high mortality rate, and potential for multiple neurologic complications. Early diagnosis and proactive neuromonitoring in the form of continuous EEG and sequential neuroimaging are essential for prompt treatment to optimize outcomes through secondary injury prevention.