SHM Converge Scientific Abstract ePoster Gallery-Salmonella Meningitis Coinfection With HHV-6 in a Previously Healthy Infant: A Rare but Critical Presentation

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This case report describes a rare but serious instance of Salmonella meningitis with concurrent HHV-6 detection in a previously healthy 6-month-old infant. The patient presented with decreased oral intake and urination, irritability, vomiting, fever, facial rash, and a three-week history of diarrhea. Initial laboratory studies were largely normal except for markedly elevated inflammatory markers, including CRP and procalcitonin. Cerebrospinal fluid analysis showed findings consistent with bacterial meningitis, including low glucose, elevated protein, and a high white blood cell count with neutrophilic predominance. CSF culture grew Salmonella, and the meningitis panel was positive for HHV-6. Brain MRI demonstrated leptomeningeal enhancement consistent with meningitis.<br /><br />The infant was initially treated empirically with vancomycin and ceftriaxone, then escalated to meropenem due to minimal improvement. Once sensitivities returned, therapy was narrowed to IV ampicillin for a total of four weeks, in line with Pediatric Red Book guidelines. Immunologic evaluation was negative, indicating no known underlying immune deficiency.<br /><br />The case highlights several important points: Salmonella can cause invasive central nervous system infection even in immunocompetent infants; gastrointestinal symptoms may precede meningitis by days or weeks; and HHV-6 detection may represent either a coincidental finding or a possible contributor to immune dysregulation and secondary bacterial infection. Despite the severity of the presentation, early recognition and treatment led to a favorable outcome, with improving inflammatory markers, no neurologic deficits, and a normal hearing test.

Asset Subtitle

Shana H. John

Meta Tag

Author List Aayushi Doshi, Caitlin Gartley, Gregory K. Ison, Shana H. John

Category Clinical Vignettes

Concept Acute Bacterial Meningitis

Concept Salmonella

Concept Antibiotic Management

Concept Cerebrospinal Fluid

Concept Culture

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Shana H. John

Track Pediatric

Keywords

Salmonella meningitis

HHV-6

infant

bacterial meningitis

cerebrospinal fluid

leptomeningeal enhancement

procalcitonin

ampicillin

immunocompetent

central nervous system infection

Acute Bacterial Meningitis

Salmonella

Antibiotic Management

Cerebrospinal Fluid

Culture