Non-typhoidal Salmonella bacteraemia without gastroenteritis: a marker of underlying immunosuppression. Review Of cases at St. Thomas' Hospital 1970-1999.
OBJECTIVE
To classify non-typhoidal salmonella bacteraemia according to clinical presentation, and to study how this correlates with the presence of underlying immunosuppression.


METHODS
We analysed data collected prospectively for all 82 cases of non-typhoidal salmonella bacteraemia presenting to St. Thomas' Hospital between 1970 and 1999.


RESULTS
Patients presented with one of three syndromes: diarrhoea, an extra-intestinal focus of infection, or isolated fever with no focus. Only 18% of those with diarrhoea had underlying immunosuppression, compared with 80% of those with extra-intestinal focal infections (P= 0.001) and 80% of those with no focus (P= 0.0001). There was no significant association between salmonella serotype and underlying immunosuppression. Salmonella enteritidis isolates, especially phage type 4, increased significantly during the last decade (P= 0.001). The presentation of non-typhoidal salmonella bacteraemia in the absence of diarrhoea prompted the diagnosis of HIV in two patients.


CONCLUSIONS
Underlying immunosuppression should be excluded in patients presenting with non-typhoidal salmonella bacteraemia in the absence of gastroenteritis. This may lead to an earlier diagnosis of HIV.
Brown
M
M
Department of Infection, St. Thomas' Hospital, London, UK.
Eykyn
S J
SJ
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000276:immunology* / Q000382:microbiology / Q000401:mortality; D003967:Diarrhea / Q000382:microbiology; D005759:Gastroenteritis / Q000382:microbiology; D006801:Humans; D007108:Immune Tolerance; D016867:Immunocompromised Host; D008131:London; D008875:Middle Aged; D012189:Retrospective Studies; D012475:Salmonella / Q000145:classification; D012480:Salmonella Infections / Q000150:complications / Q000276:immunology* / Q000382:microbiology / Q000401:mortality; D012703:Serotyping