Salmonella Paratyphi B septicemia in a Neonate
A 6-day-old baby girl presented with fever and blood in stools and vomitus since 1 day. She was a term, small for gestational age, delivered by normal vaginal delivery with a birth weight of 1.55 kg in a private hospital born to a economically poor and severely anemic mother. She was supplemented with top up feeds along with breast milk and was discharged on 3rd day. Antenatal and perinatal history was uneventful. Her Apgar score was not available. On examination she was febrile (101°F), pulse rate 160 beats/min and respiratory rate 50 breaths/min. She appeared dehydrated. Her systemic examination was unremarkable. A diagnosis of neonatal sepsis was made and baby was started empirically on intravenous piperacillin/tazobactam 80 mg/kg body weight 8th hourly and cefotaxime 60 mg/kg body weight 8th hourly. The drug was chosen based on the sensitivity pattern of the prevalent bacteria usually causing sepsis in the hospital nursery.\nScreening for sepsis was done. Laboratory investigations revealed increased C-reactive protein-169.8 mg/L, serum urea 227 mg/dl and serum creatinine was 3.6 mg/dl. Hemogram showed Hb 15.7 gm%, white blood cell count on admission was 24,200/cumm with 54% neutrophils and 40% lymphocytes 6% monocytes and platelet count of 92,000/mm3 suggesting sepsis and prerenal failure. Blood collected at the time of admission flagged positive after 8 hours by BD BACTEC 9120 (Becton Dickinson). The isolate, Gram-negative bacilli is identified as Salmonella enterica serotype Paratyphi B (Agglutinating serum, Remel Europe, Ltd) which was sensitive to ampicillin, ceftriaxone, co-trimoxazole, ciprofloxacin, cefotaxim, ceftriaxone and piperacillin/tazobactam. Stool culture was negative. CSF culture was not done as there were no symptoms of meningeal irritation. Treatment was continued with same antibiotics. Baby's condition improved with 5 days of treatment and was discharged on 9th day. Subsequently, the mother gave history of typhoid fever 3 years back. Mother's stool was cultured to rule out carrier state. Mother's stool culture yielded Salmonella enterica serotype Paratyphi B with the same antibiotic sensitivity pattern. Blood culture and Widal test were negative. Mother was advised to take treatment for carrier state and repeat stool culture after treatment. But she did not turn for follow-up.