A rare isolate of Salmonella Bareilly from a case of pancreatic pseudocyst

Reena Anie Jose; Sujith Philip; Renu Mathew; Marina Thomas

doi:10.4103/jacm.jacm_15_20

CASE REPORT

Year : 2020 | Volume : 22 | Issue : 1 | Page : 47-49

A rare isolate of Salmonella Bareilly from a case of pancreatic pseudocyst

Reena Anie Jose¹, Sujith Philip², Renu Mathew¹, Marina Thomas¹
¹ Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
² Department of Gastrointestinal Surgery, Believers Church Medical College Hospital, Thiruvalla, Kerala, India

Date of Submission	29-May-2020
Date of Decision	03-Jun-2020
Date of Acceptance	18-Jun-2020
Date of Web Publication	13-Aug-2020

Correspondence Address:
Dr. Reena Anie Jose
Department of Microbiology, Believers Church Medical College Hospital, Thiruvalla - 689 103, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jacm.jacm_15_20

Abstract

Non-typhoidal Salmonella are important food-borne pathogens that are associated with gastroenteritis, bacteraemia and focal infections. Salmonella enterica subspecies enterica serovar bareilly has been implicated in gastroenteritis and nosocomial infections. There are not much literature available on the hepatobiliary involvement by S. bareilly. We report a case of acute pancreatitis with pseudocyst. S. bareilly was isolated from blood and pseudocyst aspirate.

Keywords: Bacteraemia, pancreatitis, pseudocyst, Salmonella Bareilly

How to cite this article:
Jose RA, Philip S, Mathew R, Thomas M. A rare isolate of Salmonella Bareilly from a case of pancreatic pseudocyst. J Acad Clin Microbiol 2020;22:47-9

How to cite this URL:
Jose RA, Philip S, Mathew R, Thomas M. A rare isolate of Salmonella Bareilly from a case of pancreatic pseudocyst. J Acad Clin Microbiol [serial online] 2020 [cited 2020 Oct 29];22:47-9. Available from: https://www.jacmjournal.org/text.asp?2020/22/1/47/291888

Introduction

Salmonella enterica subspecies enterica serovar Bareilly, or Salmonella Bareilly, is a Group C1 serovar first identified in India by Bridges and Scott in 1928.^[1] Several food-borne outbreaks with S. Bareilly have been reported from the UK and the USA.^[2],[3] Only very few reports of gastroenteritis and nursery outbreaks have been reported from India.^[4] It has been among the top 20 serotypes isolated from human Salmonella infections in the USA.^[5] Here, we report a rare case of pancreatic pseudocyst with bacteraemia due to S. Bareilly.

Case Report

A 33-year-old man was admitted to the gastroenterology department with complaints of abdominal pain for one and a half months and fever with evening rise of temperature for two weeks. He had episodes of loose stools and vomiting two weeks back. He was a radiology technician by profession and was working in Delhi. He was an alcoholic for the past 10 years. On examination, there was tenderness in the left upper quadrant and left lumbar area with no hepatosplenomegaly. Laboratory investigations done on the day of admission revealed haemoglobin 9 g/dL, total count 13600/L, serum amylase 665 U/L, serum lipase 852 U/L, C-reactive protein 194 mg/L and procalcitonin 1 ng/mL. One set of blood culture samples was received on the day of admission. Contrast-enhanced computed tomography abdomen revealed acute pancreatitis, possibility of ruptured contained pseudocyst, splenic vein thrombosis and mild fatty liver [Figure 1].

Figure 1: Contrast-enhanced computed tomography abdomen showing pancreatic pseudocyst

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He was shifted to the intensive care unit on the second day as there were hyponatremia, hypocalcaemia and fever. Intravenous Imipenem was initiated. Ultrasound-guided pigtail insertion was done after one week, and the aspirated fluid was sent for culture. There was clinical improvement, and the patient was afebrile.

Blood and pus cultures from repeated samples grew non-lactose-fermenting colonies which were oxidase negative. The isolate was indole negative, acid/acid (A/A) in triple sugar iron agar with gas, but no hydrogen sulphide (H₂S), mannitol fermenting, motile, citrate utilising and urease negative. It was confirmed in VITEK 2 system and serotyping (with poly-O antisera) as Salmonella species and was sensitive to Ampicillin, Ceftriaxone, Cefixime and Imipenem and resistant to Ciprofloxacin. Additional tests were done for identifying the phenotypic variations. Glucose, sucrose, maltose and xylose were fermented with gas, H₂S was produced in lead acetate agar, yellow-coloured colonies were grown in xylose lysine deoxycholate agar (XLD) and lysine and ornithine were decarboxylated. The isolate was sent to National Institute of Cholera and Enteric Diseases, Kolkata, and identified as Salmonella enterica subspecies enterica serovar Bareilly by serotyping. The patient was discharged when his general conditions improved with in situ pigtail catheter. He was on oral Cefixime for two weeks, and drain output gradually decreased to 5–10 mL/day. Once the drain output had stopped completely, a computed tomography abdomen was done to confirm the absence of residual collection, and the drain was removed.

Discussion

Salmonella species is implicated as one among the bacterial causes of acute pancreatitis and is usually the result of Salmonella bacteraemia caused by Salmonella Typhi and Salmonella Choleraesuis, but may also occur after gastroenteritis by Salmonella Typhimurium.^[6] In our patient, S. Bareilly was repeatedly isolated from blood culture and from the aspirated pseudocyst fluid. Alcoholism was an associated feature in this patient and in other studies also. Localised infection of the pancreas by Salmonella is usually due to bacteraemia and can also occur after gastroenteritis. The possible route of infection of an infected pseudocyst may be haematogenous or lymphatic spread or infected bile reaching the pancreas via pancreatic duct.^[6]

S. Bareilly are usually implicated in food-borne community outbreaks but are also reported as nosocomial neonatal ward outbreaks due to contaminated suction machine.^[2],[3],[4] No known reports of this species of bacteria being implicated in cases of pancreatitis or pancreatic pseudocysts are available either from India or from abroad. Salmonella septicaemia usually follows oral ingestion of bacteria along with food or water. Raw tuna and bean sprouts are implicated as a source of this bacteria.^[2] Water and sewage sources are also reportedly contaminated with this bacteria according to reports from India.^[7]

In contrast to the non-sucrose-fermenting characteristic of Salmonella (except serotype Mbandaka), our strain was sucrose fermenting.^[8] This explains A/A reaction in TSI agar with no H₂S production and yellow-coloured colonies in XLD agar. This phenotypic characteristic can result in misidentification of these strains from clinical samples.

Salmonella bacteraemia is generally treated with a single bactericidal drug, a beta-lactam antibiotic (Ampicillin or a third-generation Cephalosporin) or a Fluoroquinolone depending on the antimicrobial sensitivity for a duration of 10–14 days.^[9]

Infected pancreatic pseudocysts require early drainage to control sepsis.^[10] A definitive surgical procedure, in the form of an internal drainage, is then done later if there is an external pancreatic fistula form or a residual pseudocyst. In this case, after drainage, the resulting pancreatic fistula subsided with conservative management with no residual cyst, and hence, no surgical procedure was required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgement

We acknowledge Dr. A.K. Mukhopadhyay, NICED, Kolkata, for his help in identification of the isolate by serotyping.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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