Gavrilovici Cristina, Pânzaru Carmen-Valentina, Cozma Sebastian, Mârţu Cristian, Lupu Vasile Valeriu, Ignat Ancuta, Miron Ingrith, Stârcea Magdalena
University of Medicine and Pharmacy "Grigore T. Popa" Department of pediatrics, "Sf. Maria" Children's Hospital Department of Microbiology, "Sf. Maria" Children's Hospital Department of Otorhinolaryngology, Clinical Rehabilitation Hospital, Iasi, România.
Medicine (Baltimore). 2017 Nov;96(44):e8455. doi: 10.1097/MD.0000000000008455.
Salmonella enterica subsp arizonae is a common gut inhabitant of reptiles (snakes are the most common reservoir, but it also occurs in turtles). Alhough human cases owing to this organism are exceedingly rare, it may occasionally infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Our case is the 20th one among the infections with S arizonae in children, but the 2nd one of otitis and the first of mastoiditis. The other cases had different anatomical locations, such as gastroenteritis, osteomyelitis, meningitis, ankle infection, wound infection, and sinusitis.
We report a rare case of otitis with Salmonella in a previously healthy adolescent, which was most likely acquired after bathing in a lake. The ear infection was complicated with mastoiditis. Audiometric testing showed a moderately conductive hearing loss (60 dB on pure-tone average).
Standard therapy for S arizonae was initiated. The surgery revealed a "hidden" cholesteatoma. Surgical management comprised of canal wall up mastoidectomy with attico-antrotomy and posterior tympanotomy followed by tympanoplasty.
Daily postoperative dressing care of the incision, along with antibiotic lavage of the external auditory canal packing, ensured a favorable evolution. The functional gain was important; the 1-month postsurgical pure tone audiogram indicated nearly normal hearing (a mean of 25 dB for air conduction thresholds).
Salmonella enterica serotype arizonae is a rare cause of human infection, being a common organism in reptiles, like snakes and turtles. Young children are at a particular risk for acquiring such infections. Our study might encourage further epidemiologic investigations into these infections to generate a more effective strategy among public health agencies.
亚利桑那沙门氏菌是爬行动物常见的肠道寄居菌（蛇是最常见的宿主，但也存在于海龟中）。尽管由这种微生物引起的人类病例极为罕见，但它偶尔会感染与爬行动物有密切接触史的幼儿和免疫功能低下的个体。我们的病例是儿童亚利桑那沙门氏菌感染中的第20例，但却是第二例中耳炎感染，也是第一例乳突炎感染。其他病例有不同的解剖部位，如肠胃炎、骨髓炎、脑膜炎、踝关节感染、伤口感染和鼻窦炎。
我们报告了一例先前健康的青少年患沙门氏菌性中耳炎的罕见病例，很可能是在湖中沐浴后感染的。耳部感染并发乳突炎。听力测试显示中度传导性听力损失（纯音平均听阈为60分贝）。
开始采用亚利桑那沙门氏菌的标准治疗方法。手术发现了一个“隐匿性”胆脂瘤。手术治疗包括开放式乳突根治术、鼓窦切开术和后鼓室切开术，随后进行鼓室成形术。
术后每天对切口进行换药护理，同时对外耳道填塞物进行抗生素灌洗，确保了病情的良好进展。功能改善显著；术后1个月的纯音听力图显示听力几乎正常（气导阈值平均为25分贝）。
亚利桑那肠炎沙门氏菌是人类感染的罕见病因，是蛇和海龟等爬行动物中的常见微生物。幼儿尤其容易感染此类疾病。我们的研究可能会鼓励对这些感染进行进一步的流行病学调查，以便在公共卫生机构中制定更有效的策略。
