title: Obscure manifestations of Salmonella subdural empyema in children: case report and literature review.
abstract: OBJECTIVE
  Salmonella intracranial infections, including subdural empyema and brain abscess, are rare clinical manifestations in children. The aim of this study is to investigate the clinical course of Salmonella subdural empyema in infants and children.
  
  
  METHODS
  We report a 9-month-old female infant diagnosed as Salmonella subdural empyema with clinical features of prolonged fever for more than 2 months and episodic focal seizures. Literature published between 1986 and 2010 relevant to Salmonella subdural empyema in children were reviewed. The clinical presentations and laboratory findings were analyzed.
  
  
  RESULTS
  Seventeen cases with Salmonella subdural empyema, including our index case, has been reported with detailed clinical presentation. Fever (17/17; 100%), symptoms and signs of increased intracranial pressure (8/17; 47%), seizures (8/17; 47%), and limb paralysis (8/17; 47%) were the most frequent clinical features. Among these cases, unknown causative organism prior to surgery (11/17; 65%) and prolonged fever for more than 3 weeks (5/17; 29%) were also noticed. Sixteen out of 17 patients (94%) required surgical intervention for treatment. The morbidity rate and mortality rate were 29% (5/17) and 6% (1/17), respectively.
  
  
  CONCLUSIONS
  Subdural empyema is considered to be a disease with rapid progression. However, the cases caused by Salmonella species may present a slow disease course. Surgical intervention is sometimes the only way to detect the pathogen.
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung-Kang Rd., Taichung, Taiwan, 40705.
authors.forename: Kai-Mao
authors.initials: KM
authors.lastname: Chen
authors.forename: Hsiu-Fen
authors.initials: HF
authors.lastname: Lee
authors.forename: Ching-Shiang
authors.initials: CS
authors.lastname: Chi
authors.forename: Fang-Liang
authors.initials: FL
authors.lastname: Huang
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Chang
authors.forename: Hao-Chun
authors.initials: HC
authors.lastname: Hung
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013354:Empyema, Subdural / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D012480:Salmonella Infections / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D000900:Anti-Bacterial Agents
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