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• W3166277573 abstract "Bone infections are relatively common in children, and their early diagnosis is crucial because they might damage the physis, which plays an important role in growth. Staphylococcus aureus is the most common pathogen in osteomyelitis; however, Salmonella osteomyelitis is relatively rare among healthy children. We present an unusual case of Salmonella osteomyelitis over the right calcaneus in a child without sickle cell disease. The 14-month-old male toddler exhibited a right lower limb weakness and was unable to walk or stand stably for ∼10 days. Physical examination revealed swelling and mild rigidity of the right ankle with limited dorsiflexion, absence of an open wound or scar, and standing on tiptoe position with a toe-walking gait. The total leukocyte count and erythrocyte sedimentation rate (ESR) were 17,330 cells/μL and 25 mm/h, respectively. Magnetic resonance imaging of the bilateral lower legs revealed osteomyelitis of the right calcaneus (Fig. 1), and Tc-99 m three-phase bone scan indicated increased arterial, soft tissue, and bony uptake over the right calcaneal region, which was compatible with osteomyelitis. He underwent debridement over the right calcaneus. Tissue culture revealed Salmonella group C1 growth, which was susceptible to ampicillin. Four weeks of intravenous antibiotic treatment with ampicillin was completed during hospitalization, and he was discharged well on further oral antibiotic treatment with amoxicillin for 4 weeks. The last follow-up total leukocyte count and ESR prior to discharge were 10,240 cells/μL and 12 mm/h, respectively. The serotype study of the Salmonella group C1 revealed Salmonella enterica serotype Weltevreden, which is mostly reported from aquatic environments, seafood, and patients in several Southeast Asian countries.1Hounmanou Y.M.G. Dalsgaard A. Sopacua T.F. Uddin G.M.N. Leekitcharoenphon P. Hendriksen R.S. et al.Molecular characteristics and Zoonotic Potential of Salmonella weltevreden from cultured Shrimp and Tilapia in Vietnam and China.Front Microbiol. 2020; 11: 1985Crossref PubMed Scopus (1) Google Scholar Outbreaks due to Salmonella Weltevreden were mostly reported during summer.2Antony B. Dias M. Shetty A.K. Rekha B. Food poisoning due to Salmonella enterica serotype weltevreden in Mangalore.Indian J Med Microbiol. 2009; 27: 257-258Crossref PubMed Scopus (24) Google Scholar The patient lived in Penghu County, Taiwan, an archipelago of 90 islands and islets in the Taiwan Strait. According to his parents, he developed an episode of self-limiting gastroenteritis 2 months prior to admission. He might have been infected by Salmonella at that time, and the pathogen locally invaded his right calcaneus thereafter. In a previous study, osteomyelitis occurred in 2.9% of Taiwanese children with Salmonella infections.3Chen J.A. Lin H.C. Wei H.M. Hsu Y.L. Lai H.C. Low Y.Y. et al.Clinical characteristics and outcomes of culture-negative versus culture-positive osteomyelitis in children treated at a tertiary hospital in central Taiwan.J Microbiol Immunol Infect. 2020; (Available at)https://www.sciencedirect.com/science/article/pii/S1684118220302024Crossref Scopus (1) Google Scholar It is remarkable that Salmonella typhimurium is the most common serotype in Taiwan, and in another study, S. Weltevreden infection accounted for 3.4% of cases.4Lauderdale T.L. Aarestrup F.M. Chen P.C. Lai J.F. Wang H.Y. Shiau Y.R. et al.Multidrug resistance among different serotypes of clinical Salmonella isolates in Taiwan.Diagn Microbiol Infect Dis. 2006; 55: 149-155Crossref PubMed Scopus (56) Google Scholar Although long bones are mainly involved in osteomyelitis, the calcaneus may account for 5% of all cases. Most healthy children with Salmonella gastroenteritis fully recover. To prevent Salmonella infections, it is necessary to clean equipment and to avoid eating raw food. Clean water supply and education on hygiene for food preparation and storage are important to reduce transmission. The initial signs and symptoms of osteomyelitis, often subtle and nonspecific, depend on the age of the patient. With the involvement of the lower limbs, limping gait or refusal to walk is seen in approximately half of the patients. The initiation of medical and surgical therapies within 1 week of symptom onset provides a better prognosis than delayed treatment. The contributing authors all declare no conflicts of interest." @default.
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• W3166277573 date "2021-09-01" @default.
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• W3166277573 title "A rare case of Salmonella enterica serotype Weltevreden osteomyelitis in Taiwan" @default.
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• W3166277573 doi "https://doi.org/10.1016/j.pedneo.2021.05.013" @default.
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