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Salmonella Cervical Lymphadenitis in an Immunocompetent Child Exposed to a Snake at an Educational Exhibit: A Case Report

Fermaglich, Lewis J. MD*; Routes, John M. MD; Lye, Patricia S. MD; Kehl, Sue C. PhD§; Havens, Peter L. MD

Infectious Diseases in Clinical Practice: July 2012 - Volume 20 - Issue 4 - p 289–290
doi: 10.1097/IPC.0b013e318248f138
Case Reports

Abstract: Salmonella is an organism typically associated with gastrointestinal disease after exposure to contaminated food. Reptiles are also known reservoirs of Salmonella. Infrequently, Salmonella can cause extraintestinal infections and, rarely, infections involving the neck. Here, we report a case of cervical lymphadenitis in a boy caused by Salmonella enterica subsp diarizonae (Serogroup IIIb), an isolate associated with pet snakes, after direct exposure to a snake at an educational event at his school. Although evaluation of this child’s immune system was normal, it may be important to consider specific primary immunodeficiencies in children with invasive Salmonella infections caused by rare serotypes.

This is the first report of Salmonella cervical lymphadenitis in an immunocompetent pediatric patient with a known direct reptile contact. Primary immunodeficiencies, which can predispose children to invasive Salmonella infections, are reviewed. The child’s exposure to the reptile was at a school-sponsored educational exhibit raising the public health question of whether requirements should exist to inform visitors to similar educational experiences about the potential risk for reptile-transmitted Salmonella disease.

From the *Department of Pediatrics, Captain James A. Lovell Federal Health Care Center, North Chicago, IL; †Department of Pediatrics (Division of Allergy and Clinical Immunology), Medical College of Wisconsin and the Children’s Research Institute, Milwaukee, WI; ‡Departments of Pediatrics (Division of Hospital Medicine), §Pathology and Laboratory Medicine, and ||Pediatrics (Division of Infectious Diseases), Medical College of Wisconsin and the Children’s Hospital of Wisconsin, Milwaukee, WI.

Correspondence to: Lewis J. Fermaglich, MD, Department of Pediatrics, Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Rd, North Chicago, IL 60064. E-mail: lewis.fermaglich@va.gov.

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.