The patient received numerous forms of treatment simultaneously, and it is, therefore, difficult to decide which was effective. Neither sulfadiazine nor penicillin is supposedly effective in Salmonella infections. In this case, a combination of the two drugs, plus local therapy to the joint, was followed by recovery. It is impossible to estimate tile role of the repeated transfusions or of the immunity acquired by the patient, in the subsidence of the disease.
The portal of entry is assumed to he the digestive tract. The authors' inability to culture the organism from the stool corresponds with the experience of Guthrie, who stated that the organism is rarely isolated from the faeces. In the case reported by Guthrie, the autopsy showed no intestinal lesions. Similarly, in a case reported by Boycott and McNee, the autopsy disclosed no significant intestinal lesions.
The marked trauma in the patient reported here may have favored localization of the infection to an adjacent joint. The debilitated condition of the patient may have contributed to the severity of the infection. Goulder, Kingsland, and Janeway point out that, when infection with Salmonella suipestifer occurs in epidemic form as acute food poisoning, the mortality is low; but when it occurs in endemic form, it often complicates some debilitating disease and has a considerable mortality.
Age is very important in the prognosis of bacteriaemia with this organism, according to Harvey. The mortality in patients less than twenty-five years of age was 19 pet cent. in his series, while among patients over twenty-five years of age it rose to 58 per cent.
17th United States General Hospital, Naples, Italy