Obscure manifestations of Salmonella subdural empyema in children: case report and literature review.
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.
Chen
Kai-Mao
KM
Department of Pediatrics, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung-Kang Rd., Taichung, Taiwan, 40705.
Lee
Hsiu-Fen
HF
Chi
Ching-Shiang
CS
Huang
Fang-Liang
FL
Chang
Cheng-Yi
CY
Hung
Hao-Chun
HC
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*
D000900:Anti-Bacterial Agents
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