Salmonella focal intracranial infections: review of the world literature (1884-1984) and report of an unusual case

Abstract

Focal intracranial infections are unusual manifestations of salmonellosis. Forty-three such infections have been reported in the world literature. The clinical data for 34 well-documented cases are reviewed. Eleven patients had brain abscess, 19 had subdural empyema, three had epidural abscess, and one had both subdural empyema and brain abscess. Brain abscess occurred more often in adults; in contrast, subdural empyema presented more often in children. Fever, signs and symptoms of increased intracranial pressure, change in mental status, seizures, and focal neurologic deficits were the commonest clinical features. Salmonella serotypes typhi, typhimurium, and enteritidis occurred most frequently. The precipitating factors of these infections included meningitis, trauma, and intracranial hematoma. Surgical drainage combined with systemic antibiotic therapy resulted in the recovery of 21 of 25 patients. A case of embryonal carcinoma plus seminoma of the testis with brain metastases complicated by a salmonella brain abscess is also reported. This is the first report in the world literature of a focal salmonella infection in a neoplastic lesion within the central nervous system.