Salmonella Urinary Tract Infection and Bacteremia Following Non-Typhoidal Salmonella Gastroenteritis: An Unusual Presentation

Abstract

Salmonella is primarily known to affect the gastrointestinal tract but can rarely cause infections at uncommon sites, such as the urinary tract. It is known that Salmonella can infect the urinary tract directly by blood, fecal contamination of urethra, urolithiasis, or secondary intraluminal ascending infection. Our patient is a 59-year-old female with a past medical history of nephrolithiasis and multiple urinary tract infections (UTI) who presented with altered mental status and sepsis complicated by Salmonella bacteremia and UTI. Urine and blood cultures revealed Salmonella species > 100,000 colony-forming units per milliliter (CFU/mL) and non-typhoidal Salmonella, respectively. During the course of her hospital admission, the patient was treated with multiple antibiotics. On further review, it was noted that the patient had presented to the emergency room (ER) about four months earlier with abdominal pain and watery diarrhea with a stool culture being positive for non-typhoidal Salmonella. Gastroenteritis, sepsis, and enteric fever are normally known with Salmonella enterica serotype Typhi (S. Typhi). Less common extraintestinal diseases like UTI are due to non-typhoidal Salmonella. The most frequent pathogenesis of Salmonella UTI is probably hematogenous. UTI caused by non-typhoidal Salmonella is usually associated with structural abnormalities of the urinary tract. In our case, the patient had non-typhoidal Salmonella gastroenteritis followed by non-typhoidal Salmonella bacteremia and UTI.

Keywords: bacteremia; gastroenteritis; non-typhoidal salmonella (nts); salmonella infection; urinary tract infection.

Figure 1. Left renal edema and hydroureteronephrosis

Figure 2. Acute obstructing calculi in the distal left ureter