During the period 1971-1982, 57 salmonella strains other than S. typhi and S. paratyphi were isolated from sites other than stools and blood. Cerebrospinal fluid was the commonest specimen followed by urine and pus. The commonest serotypes of the 22 encountered were S. typhimurium and S. enteritidis. Twenty-four of the 57 patients were children under one year of age. These findings highlight the need to remember the unusual manifestation of salmonellosis in differential diagnoses.
Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a gram-negative intracellular bacillus. Tuberculosis, also an infectious disease, is caused by Mycobacterium tuberculosis, an acid fast bacillus. In both diseases, patients commonly present with fever and respiratory symptoms due to sepsis which might lead to respiratory failure or sudden death if left untreated. Not only are these two entities similar in clinical presentation, but the autopsy findings may mimic each other, giving rise to difficulties in determining the cause of death. We report a case of melioidosis and compare it to a typical case of miliary tuberculosis. Similarities between the cases on gross and histopathological examinations are discussed. In such circumstances, microbiological culture of bodily fluids and internal organs should be performed to ascertain the correct cause of death.
Rhodotorula species are increasingly being identified as a cause of fungal infection in the central nervous system, especially in patients with compromised immunity. The diagnosis could easily be missed due to low index of suspicion, as cryptococcus meningitis and cerebral toxoplasmosis are more common amongst immunocompromised hosts. To date, there are six cases of Rhodotorula-related meningitis reported, and three are associated with human immunodeficiency virus infection. In this report, a case of a Malaysian male with underlying human immunodeficiency virus infection who developed Rhodotorula mucilaginosa meningitis is presented. High-grade fever and severe headaches were the complaints presented in three previous case reports. India ink and nigrosin stainings were performed in the two previous reports and both revealed positive results. R. mucilaginosa were isolated from the culture of the patient's cerebrospinal fluid in all three previous reports. Predominant lymphocyte infiltration in the cerebrospinal fluid examination was documented in two reports. CD4 counts were above 100/µl in two previously published reports, while another report documented CD4 count as 56/µl. Amphotericin B and itraconazole are identified to be the first line of antifungal used and as the maintenance therapy, respectively. The possibility of relapse cannot be excluded as it was reported in the first report. It was also revealed that the current case has almost similar clinical presentation and therapeutic outcome as compared to the published reports, but some differences in diagnostic details were to be highlighted.
Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.