Salmonella meningitis in children at Texas Children's Hospital

Salmonella spp., a common cause of gastroenteritis, can result in invasive infections in children. While reported in developing countries, Salmonella meningitis has rarely been described in the United States. To evaluate the incidence and clinical characteristics of Salmonella meningitis at Texas Children's Hospital, we conducted a retrospective chart review to identify children up to 18 years of age with positive cerebrospinal fluid cultures for Salmonella from 2000 to 2010. Salmonella meningitis occurred in 7 of 112 (6.5%) cases of invasive Salmonella infection in children at our institution. Non-typhi Salmonella species were isolated in all cerebrospinal fluid samples, but only one had bacteremia. Patients were otherwise healthy infants under 4 months of age with no travel history. The most frequent symptoms at presentation included irritability, fever and diarrhea. Management and treatment regimens were varied. All infants survived and recovered without sequelae. Patients who received longer duration of intravenous antibiotics had a longer hospital stay, required central venous access, and developed side effects from medications. Non-typhi Salmonella meningitis was exclusively diagnosed in healthy infants younger than 4 months of age, and was not associated with high morbidity or mortality. Evaluation for meningitis is warranted in infants with gastroenteritis and systemic symptoms such as fever and irritability. The management of non-typhi Salmonella meningitis in children is not standardized and deserves further evaluation.