Relapsing Salmonella Meningitis in an Infant: A Case Report and Review of the Literature.

Authors

Sonia Alexiadou, Elpis Mantadakis, Ioanna Irakleidou, Stavroula Kalatzi, Eleni Myrtzaki, Evlampia A Psatha, Dimitrios Cassimos

Published in

Case reports in pediatrics. Volume 2026. Pages 6662180. Epub Aug 17, 2026.

Abstract

Accurate diagnosis of bacterial meningitis is critical, particularly in young febrile infants. Although commercially available multiplex PCR assays enable rapid pathogen detection, these typically do not include Salmonella spp. or other Enterobacteriaceae, which may result in missed diagnoses and/or inappropriate treatment duration. We report the case of a 2-month-old female infant with Salmonella enteritidis meningitis and concurrent bacteremia. The patient initially presented with fever, lethargy, and a bulging anterior fontanelle. Cerebrospinal fluid (CSF) analysis was highly suggestive of bacterial meningitis. However, both CSF culture and the FilmArray ME Panel were negative, likely due to prior empirical antibiotic therapy at another hospital. The causative organism was isolated on blood cultures. The infant was treated with intravenous ceftriaxone for 24 days and discharged in excellent clinical condition. Twelve days later, she was readmitted with a relapse of meningitis and bacteremia caused by the same pathogen. She received combination therapy with cefotaxime and cotrimoxazole for 37 days, followed by cefotaxime monotherapy for another 26 days. Immunological evaluation, including assessment of immunoglobulin levels, lymphocyte subsets, and interferon-γ receptor and Interleukin-12 receptor expression, was normal. The patient had a favorable outcome with complete clinical and laboratory recovery and a normal neurodevelopmental outcome at follow-up. Salmonella meningitis is a rare but life-threatening condition in infants, which may be overlooked when relying on molecular diagnostic panels that do not include this pathogen. Negative CSF PCR results should be interpreted with caution in the presence of typical cytological and biochemical findings of bacterial meningitis. Prolonged antimicrobial therapy of at least 4-6 weeks is essential to prevent relapse and ensure optimal microbiologic and clinical outcomes.

PMID:
42609504
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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