[Urinary Salmonella Enteritidis Carriage in a Patient Living with HIV].

Abstract

Non-typhoidal Salmonella (NTS), a major public health problem worldwide, frequently causes gastrointestinal infections and can develop asymptomatic carriage. Isolation of NTS in urine and urinary carriage, are extremely rare and their frequency increases in the presence of predisposing factors. In today’s world where the rates of quinolone-resistant Salmonella spp. are rapidly increasing, the implementation of the correct treatment protocol, especially in patients in the risk group, is the most fundamental step to prevent the development of carriage. In this case report, an human immunodeficiency virus (HIV)- infected patient with urinary carriage of Salmonella Enteritidis was presented. A 59-year-old male patient applied to the outpatient clinic with dysuric complaints. He was being followed for HIV infection and was receiving appropriate antiretroviral therapy. He had coronary artery disease, hypertension, chronic renal failure and nephrolithiasis. Physical examination was normal without fever. Salmonella spp. grew in urine culture and S.Enteritidis was reported by serotyping. The susceptibility profile was determined as sensitive to ampicillin, ceftriaxone, cefotaxime and trimethoprim/sulfamethoxazole by disk diffusion and resistant to ciprofloxacin (MIC= 0.19 mg/L) by gradient test. Lower urinary tract infection (UTI) was considered and five-day cefixime treatment was started. The patient’s complaints did not improve after treatment and S.Enteritidis was grown again in the culture. Salmonella spp. was not grown in the stool sample obtained from the patient who was learned to have gastroenteritis recently. The patient was treated with cefixime for two more weeks and there was no growth in the control culture. A few weeks later, urinary symptoms recurred and S.Enteritidis growth was again observed in urine culture and treatment was planned. Urological evaluation revealed bilateral multiple stones and cortical cysts and it was stated that operation was not possible. Twelve isolates determined from the urine cultures of the patient for 27 months were genotyped using AP-PCR and it was shown that all isolates were of the same genotype. During the patient’s follow-up, bacteriuria persisted for 27 months whether the patient was symptomatic or asymptomatic and this was associated with HIV infection and underlying nephrolithiasis. The present case was considered as NTS-induced UTI after possible Salmonella gastroenteritis and asymptomatic urinary carriage during follow-up. When NTS-induced UTI is detected, patients should be evaluated for the presence of risk factors. Elimination of risk factors is critical to achieve complete cure and prevent carriage. Otherwise, even long-term antibiotic therapy may be inadequate. Increasing resistance rates to fluoroquinolones, one of the first choices for the treatment and decolonization of Salmonella infections, are alarming. In addition to rational drug use, it is important to carefully regulate policies on antimicrobial use in the agriculture and livestock sector, which have been shown to play a major role in the development of drug resistance. In addition, considering the number of people living with HIV, NTS infections should be kept in mind in the follow-up of these patients and patients should be monitored for carriage.