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Vertebral Osteomyelitis Due to Salmonella Typhi: Case Report and Review of the Literature

Misra, Richa MD*; Srivastava, Arun Kumar MS, MCh; Prasad, Kashi Nath MD*; Dhole, Tapan Nirodhechandra MD*

Infectious Diseases in Clinical Practice: March 2013 - Volume 21 - Issue 2 - p 85–90
doi: 10.1097/IPC.0b013e31826e8152
Review Articles

Existing data on vertebral osteomyelitis due to Salmonella enterica serotype typhi are rare. A 53-year-old man was referred to the outpatient department of a tertiary care center with a 4-month history of low back pain accompanied by fever. We did a Medline search of the English-language literature on Salmonella typhi vertebral osteomyelitis and reviewed reference lists for additional cases published since the year 1900. Our search yielded only 19 cases. There was male predominance with 1.6:1 distribution and predominance of lumbar involvement. Fever and back pain were the predominant signs and symptoms present in 100% of cases. None of the cases had diarrhea or abdominal discomfort. The erythrocyte sedimentation rate was elevated consistently. Stool and blood cultures were positive in 1 and 2 cases, respectively. The Widal test was positive in 13 cases. One case each was associated with sickle-cell disease and abdominal aortic aneurysm. Diabetes mellitus was present in 3 cases. Only one case presented with neurological deficit. The duration of symptoms before diagnosis ranged from 15 days to 12 years. Paravertebral abscess was present in 3 cases, whereas an epidural abscess was noted in 2 cases. Fifty percent of cases required surgical intervention, whereas the rest were managed on antibiotics alone. The overall mortality was 10.5%. The key to diagnosis is bacterial culture of aspirated specimen. Salmonella and tuberculous spondylitis must be differentiated because both have similar epidemiological and clinicoradiologic presentations. The emergence of nalidixic acid resistance is associated with fluoroquinolone therapeutic failures.

Misra et al. have reported the unusual finding of a vertebral osteomyelitis caused by serovar Typhi that was initially misdiagnosed as tubercular osteomyelitis. There is emphasis on the difficulties in making a radiologic diagnosis and the value of obtaining bacterial cultures. The susceptibility pattern of the isolated organism highlights the emerging problem of antimicrobial resistance in serovar Typhi.

From the *Departments of Microbiology and †Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Correspondence to: Richa Misra, MD, Department of Microbiology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, India 226014. E-mail:

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

© 2013 by Lippincott Williams & Wilkins.