Septic shock caused by Salmonella: still drawing attention

Abstract

Salmonella infection is uncommon, but carries a high mortality rate if the patient develops
hemodynamic instability. It predominantly affects children and the elderly. The mechanisms
by which nontyphoidal Salmonella causes urinary tract infection are generally attributed to
hematogenous spread resulting from gastroenteritis or to the introduction of fecal microbiota
through the urethra. In this case, the patient presented with a clinical picture characterized by
the onset of watery stools accompanied by emesis and followed by urinary symptoms.
The presented clinical features prompted the development of this case report, which aims to
provide guidance in identifying risk factors and clinical manifestations that may raise suspicion of
Salmonella as the etiology. The patient had a history of acute gastroenteritis, after which urinary
symptoms and septic shock developed. The bacillus was isolated in both blood and urine cultures
and was found to be sensitive to ciprofloxacin, the first-line antibiotic due to its intracellular
activity. This case underscores the importance of rational antibiotic use in the light of the
emergence of beta-lactamase-producing Salmonella in Paraguay.
This case report is noteworthy due to the infrequency of urinary tract infections with septic shock
caused by Salmonella. In this context, it is important not only to know the clinical syndromes that
may be attributed to this bacillus, but also to highlight the patient’s socioeconomic background,
since the infection is associated with the consumption of contaminated liquid or food.