Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review

Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review Lixin Lou, Fangqi Li, Bo Qian, Kaiyu Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6793263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract A 62-year-old Asian woman with multiple organ involvement due to Salmonella infection (including heart valves, bone marrow, and central nervous system) was reported. She initially presented with fever and hip pain, and blood cultures showed Salmonella infection. Her condition progressed to sepsis, septic shock, nephritis, osteomyelitis, and cerebral infarction. After admission, antibiotics were upgraded, but she later developed infective endocarditis, requiring long-term intravenous antibiotics and eventually oral Faropenem therapy. Timely blood cultures, lesion assessment, and antibiotic adjustments are crucial for managing Salmonella infections and improving outcomes. This case uniquely presents a 62-year-old Asian woman with rapid progression of Salmonella infection to multi-organ involvement including sepsis and cerebral infarction, rarely seen in adults. Salmonella Typhi Osteomyelitis Infective endocarditis Widal reaction Case report Figures Figure 1 Case A 62-year-old Asian female was presented in our hospital with 1-month history of fever and 2-week history of hip joint pain on September 24, 2022. She had chills and shivering a month ago, along with a fever that seemed to have no apparent reason, weakness, rambling, and unconsciousness. Blood cultures at the local hospital revealed a possible Salmonella infection; gentamicin and amikacin resistance were found, as well as cefepime, cefotaxime, imipenem, and meropenem sensitivity; sepsis and septic shock were confirmed. After anti-infective treatment in Intensive Care Unit (ICU) and two hemofiltration treatments, she developed severe peri-nephritis. The patient felt pain in her right hip joint while receiving treatment in the urology department. An MRI revealed septic osteomyelitis. Following anti-infective treatments, including vancomycin in orthopedic surgery, the hip joint lesion worsened, and the patient was transferred to our department for further care. This patient had a history of underlying hypertension and diabetes mellitus. Glasgow's score upon entrance was 8, while the SOFA score was 3. Laboratory tests on admission: leukocytes 10.14×10^9/L, absolute neutrophils 6.41×10^9/L, hemoglobin 95 g/L, platelets 348×10^9/L. C-reactive protein (CRP) 115.99 mg/L, procalcitonin 0.15 ng/mL, hemosiderin 86 mm/1h, ferritin 850.88ug/L. Cardiac ultrasound (US) showed mild aortic stenosis with mild insufficiency of closure, left atrial and left ventricular enlarged. MRI of both hips suggests septic osteomyelitis. Cephalic MRI indicated that left basal ganglia signal not excluding cerebral infarction. Following admission, the patient's four blood cultures were all negative. Next-generation sequencing (NGS) of whole blood and stool culture both yielded negative results. Widal reaction: S. typhi : 1:640 (reference: 0–1:80), S. typhi : 1:320 (reference: 0–1:160). We empirically applied CRO (ceftriaxone) (2.0 g, QD), however, the temperature and inflammatory parameters didn’t improve. 3 days later, the antibiotic was upgraded to meropenem (2.0 g, Q8H) in conjunction with the blood culture sensitivity test at the outside hospital, the patient's temperature returned to normal, and the inflammatory parameters improved significantly. However, 3 days after applying meropenem, the patient developed fever again, with a higher white blood cell count of 14.31×10^9/L. The possibility of exacerbating septic osteomyelitis or developing additional lesions was evaluated. Repeated US of the hip joint revealed that the effusion had not increased significantly compared to before, that the site was quite deep, and that it was still impossible to puncture and extract pus; at this point, transesophageal echocardiography revealed that the aortic valve had increased echogenicity and thickening, that the surface was rough, and that the opening was mildly restricted, and that the aortic valve vegetation had formed. Infective endocarditis was confirmed, and meropenem was maintained. After 4 weeks, the patient's awareness improved, and her body temperature returned to normal, and the inflammatory parameters were clearly lowered, then she received anti-infective therapy at a local hospital for 1 month. Follow-up hip MRI and cardiac US were improved, the head MRI revealed lesion shrinking, and meropenem was reduced to 1g, Q8H. She was discharged from the local hospital six weeks later, and was treated with chronic faropenem suppression by oral. The patient and her family expressed satisfaction with the entire treatment process. The Fig. 1 summarizes the entire course of the patient's onset. Discussion Salmonella infections cause fever and slow pulse, with rare multi-organ involvement. Patients with Salmonella bacteremia may develop hard-to-diagnose migratory lesions. We reported a case of S. typhi affecting multiple organs (heart valves, bone marrow, brain, kidneys) to highlight the need for dynamic monitoring and awareness of multi-organ infections. S. infective endocarditis is rare and fatal, no standard treatment strategy has yet been established. Cheng et al. summarized typhoid and nontyphoid S. infective endocarditis reported from 1976-2014, the overall mortality rate was 42.5% (37/87) in 87 patients and decreased over time [1]. With advances in detection and standardization of treatment, the mortality rate of S. infective endocarditis has been decreasing annually; therefore, we further summarized the characteristics, treatment regimens, and regressions of S. infective endocarditis published in 2014-2024. to provide guidance for the clinical management of S. infective endocarditis. Between 2014 and 2024, a total of 18 cases of S. infective endocarditis caused by typhoid and non-typhoid were searched, including the case that was described (Table 1). The most common infection was caused by S. enteritidis (55.6%). 12 of the patients were male, with a median age of 53 years old. A total of 11 patients (61.1%) were 50 years of age or older. 8 of the patients had heart disease, 4 had heart valve replacements, 6 had immune system disorders or diabetes, and just 1 patient had no underlying medical conditions. Table 1. Clinical characteristics and regression of patients with endocarditis caused by typhoid and non-typhoidal Salmonella during 2014-2024. Ref. Pathogen Detection method Age (y)/Sex Underlying disease Clinical symptoms Involved valve Prosthesis Other extraintestinal infections Antibiotic/ Duration Valvular Surgery Outcome Ortiz et al. (2014)[2] S. enteritidis Blood culture 73/F Asthma, hypertension, and replacements of both mechanical mitral and bioprosthetic aortic valves Nausea, diarrhea, fevers, and weakness Mitral valve Yes urinary tract infection GEN + AZT (IV) No Dead Laganà et al. (2017)[3] S. enterica PT 35 Autopsy 75/M Systemic arterial hypertension, psoriasis, AF Emesis, diarrhea NA No Pulmonary and systemic embolism NA No Dead Piyasiri et al. (2017)[4] S. Paratyphi A Blood culture 25/NA Non Fever, headache Mitral valve No No CRO (IV, 4 weeks) →AZM (oral, 1 week) No Alive Lam et al. (2018)[5] S. enteritidis Blood culture 55/M Congenital cardiomyopathy Fever Mitral and aortic valve Yes Splenic infarction CRO (IV, 6 weeks) →TMP/SMX (oral, as chronic suppressive therapy) No Alive Ronson et al. (2018)[6] S. enterica serovar Typhi Blood culture 20/M Non Fever, headache and diarrhea Mitral valve No No CRO (IV, 6 weeks) →CIP (oral, 6 weeks) No Alive Dickter et al. (2019)[7] S. enterica serotype Mbandaka Blood and stool cultures 69/M Abdominal aortic aneurysm, atrial septal defect status, SSS, primary myelofibrosis with JAK2 mutation, secondary acute myelogenous leukemia, GVHD, acute DVT Abdominal pain, diarrhea Mitral valvular No No CRO (IV, 6 weeks) No Alive Youssef et al. (2019)[8] S. typhimurium Blood culture 36/F AIDS cough, shortness of breath, fever, chills and night sweats, diarrhea Eustachian valve No No CRO (IV, 5 days)→CIP (oral, 4 weeks) No Alive Connolly et al. (2021)[9] S. enteritidis Blood culture In 50s/F Aortic and mitral valve replacement, LIMA to LAD CABG, hypothyroidism, COPD, and lower limb vascular stents Fevers, rigors, dyspnoea, chest discomfort, cough with coryza, nausea, vomiting Mitral valve Yes No CRO+CIP (6 weeks)→ medium to long-term suppressive antibiotics to prevent relapse No Alive Dhayhi et al. (2021)[10] S. enterica subspecies salamae (subgroup II) Blood culture 7/F SCA Fever, jaundice, abdominal pain, and respiratory distress Inferior vena cava-right atrium junction No No CIP + CTX (IV, 6 weeks)→AM (2 weeks) No Alive Mishra et al. (2021)[11] S. species serotype O&H Blood culture 50/M NA Chest pain, fever and altered mental status Aortic valve No No FEP (IV, 6 weeks) + LEV (oral) No Alive Alhamadh et al. (2022)[12] S . (group C and D) Blood culture 56/M T2DM, hypertension, chronic anemia, AF, non-ICM, and RHD status post mitral and aortic valves replacement Fever, chills, rigors, cough and mild shortness of breath. Aortic valve Yes Splenic infarction, aortic pseudoaneurysm and acute kidney injury CRO + GEN (IV) Yes (Commando surgery) Alive Rzucidło-Resil J et al. (2022)[13] S. enterica Blood culture 39/M Non Fever Mitral and aortic valve No Splenic infarction CRO + TMP/SMX Yes (cardiac transplantation) Alive Murray et al. (2023)[14] S. enteritidis Blood culture and WGS 26/M HIV and HCV, regular injection drug use Fever, cough and dyspnoea Mitral valve No Embolization and acute arterial occlusion of the left arm AMP + CIP (6 weeks) Yes (mitral valve replacement) Alive van Kruijsbergen et al. (2023)[15] Non-(para)typhi Salmonella group D strain Blood culture In 80s/M CKD, COPD and TAVI Fever, lower abdominal pain and diarrhea Aortic valve Yes No CRO (IV, 6 weeks) No Dead Winicki et al. (2023)[16] S. typhimurium Blood culture 57/M Drug use history Diarrhea, nausea, chills, and oliguria Aortic valve No No CRO + LEV (6 weeks) No Alive Zahoor et al. (2023)[17] Salmonella typhi. Blood culture 25/M Non Cough, fever, shortness of breath, and hemoptysis Aortic valve No No CRO + meropenem No Alive Alqallaf et al. (2024)[18] Salmonella Splenic abscess pus culture 60/M IHD, T2DM, hypertension, and CKD Fever, crampy left sided abdominal pain, and irritability Aortic valve No splenic infarction, and abscess 45 days of ceftriaxone and two weeks of gentamycin No Alive Abbreviations: AZT, aztreonam; AZM, azithromycin; AML, acute myelogenous leukemia; AIDS, acquired immunodeficiency syndrome; AF, atrial fibrillation; CRO, ceftriaxone; AM, amikacin; COPD, chronic obstructive pulmonary disease; CIP, ciprofloxacin; CTX, cefotaxime; CKD, chronic kidney disease; CABG, coronary artery bypass grafting; DVT, deep vein thrombosis; FEP, cefepime; GVHD, graft-versus-host disease; GEN, gentamicin; ICM, ischemic cardiomyopathy; IHD, ischemic heart disease; LIMA, left internal mammary artery; LAD, left anterior descending; LEV, levofloxacin; SLE, systemic lupus erythematosus; S., salmonella; SSS, sick sinus syndrome; SCA, sickle cell anemia; SMX, sulfamethoxazole; T2DM, type 2 diabetes mellitus; TAVI, transcatheter aortic valve implantation; TPM, trimethoprim; WGS, whole genome sequencing. Remarkably, of the seven patients under 50 years of age, one was a 7-year-old child whose onset of disease might have been due to the presence of SCA, the other 6 patients were between 20 and 39 years of age, and 2 of them were HIV positive. The other 4 patients did not disclose any underlying illnesses or immunocompromise. This means that even previously healthy individuals with Salmonella infection can develop infective endocarditis, so careful monitoring of patients for any health changes is needed. The prodromal symptoms of infective endocarditis are atypical; the most common symptoms are fever (88.9%) and gastrointestinal symptoms (61.1%), and the cardiac valves involved include mitral valve (50%), aortic valve (50%), eustachian valve (5.6%) and inferior vena cava-right atrium junction (5.6%). 8 patients combined with other extra-intestinal complications, with splenic infarction being the most prevalent (4/8). The majority of patients were treated conservatively (83.3%) and most received third-generation cephalosporins (15/18), which were generally applied for 6 weeks. Half of the patients got combinations, and 5/18 patients had persistent suppressive treatment with medium- and long-acting antibiotics. Three individuals died ultimately, with a mortality rate of 16.7%. All three patients were old with underlying cardiac illness, and two had previously undergone heart valve replacement. The mortality rate of S. infective endocarditis was approximately the same compared to cases in the previous decade (13.3% vs. 16.7%), and with the better understanding of S. endocarditis, more and more S. endocarditis has been reported, with third-generation CROs and quinolone s remaining the standard treatment options. Diagnosing S. infection is challenging due to nonspecific early symptoms like fever and joint pain, antibiotic overuse, and difficulty obtaining biopsies. Once diagnosed, antibiotics should be started immediately based on sensitivity tests and clinical experience. Treatment duration should be extended for migratory lesion infections. Patients should be closely monitored for temperature, consciousness, and inflammatory markers, and antibiotics adjusted as needed. Conclusion This case involves a variety of complex diseases and complications, such as septic osteomyelitis and infective endocarditis, and thus holds significant value for medical education. Although the patient's condition was described in detail, there may still be information that was not discovered or not recorded, which could affect the comprehensive understanding of the entire case. Typhoid can cause rare but serious complications. Fever patients should get blood cultures quickly. Even if results are negative, watch closely and consider complications. Treat with long-term IV antibiotics and surgery if needed. Abbreviations MRI magnetic resonance imaging SOFA sequential Organ Failure Assessment US Cardiac ultrasound NGS Next-generation sequencing CRO ceftriaxone AZT aztreonam AZM azithromycin AML acute myelogenous leukemia AIDS acquired immunodeficiency syndrome AF atrial fibrillation CRO ceftriaxone AM amikacin COPD chronic obstructive pulmonary disease CIP ciprofloxacin CTX cefotaxime CKD chronic kidney disease CABG coronary artery bypass grafting DVT deep vein thrombosis FEP fluorinated ethylene propylene GVHD graft-versus-host disease GEN gentamicin ICM ischemic cardiomyopathy IHD ischemic heart disease LIMA left internal mammary artery LAD left anterior descending LEV levofloxacin SLE systemic lupus erythematosus SSS sick sinus syndrome SCA sickle cell anemia SMX sulfamethoxazole T2DM type 2 diabetes mellitus TAVI transcatheter aortic valve implantation TPM trimethoprim WGS whole genome sequencing Declarations Acknowledgements Not applicable. Author contributions Lou Lixin and Li Fangqi are responsible for writing the manuscript. Qian Bo is in charge of the tables and illustrations. Zhang Kaiyu is responsible for the review. Funding This research was funded by Jilin Provincial Department of Science and Technology ( 20200201616JC) to KZ. Data availability Data is provided within the manuscript. The corresponding author, Kaiyu Zhang, can be contacted to obtain the raw data. Her email is [email protected] Ethics approval and consent to participate The study was conducted in accordance with the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of the First Hospital of Jilin University. Written informed consent was obtained from each individual. Consent for publication Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. Competing interests The authors declare no competing interests. References Cheng WL, Li CW, Li MC, Lee NY, Lee CC, Ko WC. Salmonella infective endocarditis. J Microbiol Immunol Infect. 2016;49(3):313–20. Ortiz D, Siegal EM, Kramer C, Khandheria BK, Brauer E. Nontyphoidal cardiac salmonellosis: two case reports and a review of the literature. Tex Heart Inst J. 2014;41(4):401–6. Laganà P, Delia S, Dattilo G, Mondello C, Ventura Spagnolo E. A case of Infective Endocarditis due to Salmonella enterica phagetype 35. First report. Clin Ter. 2017;168(6):e397–400. Piyasiri DL, Chandrasiri P, Jayasinghe HS, Pathirage S, Sapukotana PM, Gamage TS. Salmonellosis beyond the gastrointestinal tract: a case series. Ceylon Med J. 2017;62(4):240–1. Lam PW, Tumarkin E, Bogoch II. Medical management of Salmonella enteritidis prosthetic valve endocarditis with multiple infectious foci. Infection. 2018;46(3):435–6. Robson C, O'Sullivan MVN, Sivagnanam S. Salmonella enterica Serovar Typhi: An Unusual Cause of Infective Endocarditis. Trop Med Infect Dis 2018, 3(1). Dickter JK, Cai L, Snyder DS. Endocarditis following Consumption of Cereal Associated with Salmonella enterica Subtype Mbandaka Outbreak. Case Rep Infect Dis 2019, 2019:5464230. Youssef D, Marroush TS, Tanveer F. A case report of eustachian valve endocarditis due to Salmonella typhimurium in an AIDS patient. Germs. 2019;9(3):154–7. Connolly G, Kale M, Ustianowski A. Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis. BMJ Case Rep 2021, 14(6). Dhayhi NS, Shamakhi AE, Hakami MH, Alluli HM, Bahkly TN, Faqehi HH, Alqahtani HM, Alsum A, Ezadeen HH. Rare presentation of infective endocarditis due to Salmonella entrica subspecies salamae (subgroup ll) in a sickle cell anemia girl. IDCases. 2021;25:e01184. Mishra K, Cu C, Abolbashari M, Ojha CP, Cervantes JL, Alkhateeb H. Slither Into the Heart: Salmonella Endocarditis Following Rattlesnake Meat Ingestion. Cureus. 2021;13(7):e16466. Alhamadh MS, Alanazi RB, Alhowaish TS, Alhabeeb AY, Algarni ST, Wadaan OM, Suliman I, Al-Ghamdi MG. Refractory Salmonella Prosthetic Valve Endocarditis Complicated by Splenic Infarction and Aortic Pseudoaneurysm in a Patient with Double Prosthetic Valves: A Case Report. Diagnostics (Basel) 2022, 12(8). Rzucidło-Resil J, Golińska-Grzybała K, Przybylski R, Kapelak B, Gajos G, Gackowski A. A complicated course of Salmonella endocarditis leading to heart transplantation. Kardiol Pol. 2022;80(9):945–6. Murray L, Venter M, Le Grange M, Meel R. Non-typhoid Salmonella endocarditis complicated by cardiac failure and acute limb ischaemia in a person living with HIV and hepatitis C: A case report and literature review. IDCases. 2023;32:e01747. van Kruijsbergen BWA, Spiegelenberg JP, van Lieshout M, Heuvelmans M. Non-typhoidal Salmonella enteritidis prosthetic valve endocarditis. BMJ Case Rep 2023, 16(11). Winicki NM, Desai D, Desai A, Perswani P, Smadi KA, Doyle K, Gandhi H, Sethi PS, Mukherjee A. From Gut to Heart': A rare case of Salmonella Typhimurium Bacteremia and native valve endocarditis. IDCases. 2023;32:e01787. Zahoor M, Ahmad K, Kakakhel M, Yousaf A, Saleh M, Sayyar M, Ali Y. Multidrug-Resistant Salmonella Endocarditis of a Native Valve: A Rare Case Presentation. Cureus. 2023;15(11):e48396. Alqallaf ZY, Maadarani OS, Elhabibi ME, Abdelfatah M, Bitar ZI. Point of Care Ultrasound Used to Diagnose Nontyphoidal Endocarditis. Pocus j. 2024;9(1):29–32. Additional Declarations No competing interests reported. Supplementary Files CAREchecklistEnglish2013.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6793263","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":469908640,"identity":"476d1743-08ad-4a90-8289-acc7a0140417","order_by":0,"name":"Lixin Lou","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Lixin","middleName":"","lastName":"Lou","suffix":""},{"id":469908643,"identity":"48aabc6f-f88c-402f-8186-2ac69103bd28","order_by":1,"name":"Fangqi Li","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Fangqi","middleName":"","lastName":"Li","suffix":""},{"id":469908646,"identity":"dbc41319-cd65-4624-a5dd-ad4f46ae3c1e","order_by":2,"name":"Bo Qian","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Qian","suffix":""},{"id":469908648,"identity":"e472a8c3-0969-40e0-aa6e-f4e7edcbb984","order_by":3,"name":"Kaiyu Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACCQbGBgaGCjYZCId4LWfYeEjRAgSMbQwkaJFsP9wmzTuPj8fgAPPB2zwMdnkEtUjzJAK1bGMDamFLtuZhSC4mqEWOAa6Fx0yah+FAYgNBLfwPgVrmgLTwfyNOi7QEyJYGsC1sxGmRnPGw2XLOMTYeycNsxpZzDJIJa5E4n/7wxpuaY3J8x5uBjAo7wlqAgAUYHccYGJhBbAMi1AMB8wcGhhrilI6CUTAKRsHIBACjoDJh/uuhsQAAAABJRU5ErkJggg==","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":true,"prefix":"","firstName":"Kaiyu","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-06-01 01:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6793263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6793263/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84689541,"identity":"7c016e35-be15-43e8-a7fa-9556f6abadf1","added_by":"auto","created_at":"2025-06-16 09:30:59","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":299447,"visible":true,"origin":"","legend":"\u003cp\u003eThe patient's medical journey.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6793263/v1/a0ff2c2a01f8822d48972344.jpeg"},{"id":89035083,"identity":"067a6e1b-5321-4b82-bee0-92268b65d02b","added_by":"auto","created_at":"2025-08-14 03:46:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":820379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6793263/v1/e844ea1c-096f-4c6f-b7a9-c65c8f0d8b09.pdf"},{"id":84689534,"identity":"a88b187e-6ee5-4b3b-915a-c2564646dda6","added_by":"auto","created_at":"2025-06-16 09:30:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":93137,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklistEnglish2013.docx","url":"https://assets-eu.researchsquare.com/files/rs-6793263/v1/165a27b90a3ca126ac49c603.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review","fulltext":[{"header":"Case","content":"\u003cp\u003eA 62-year-old Asian female was presented in our hospital with 1-month history of fever and 2-week history of hip joint pain on September 24, 2022. She had chills and shivering a month ago, along with a fever that seemed to have no apparent reason, weakness, rambling, and unconsciousness. Blood cultures at the local hospital revealed a possible \u003cem\u003eSalmonella\u003c/em\u003e infection; gentamicin and amikacin resistance were found, as well as cefepime, cefotaxime, imipenem, and meropenem sensitivity; sepsis and septic shock were confirmed. After anti-infective treatment in Intensive Care Unit (ICU) and two hemofiltration treatments, she developed severe peri-nephritis. The patient felt pain in her right hip joint while receiving treatment in the urology department. An MRI revealed septic osteomyelitis. Following anti-infective treatments, including vancomycin in orthopedic surgery, the hip joint lesion worsened, and the patient was transferred to our department for further care. This patient had a history of underlying hypertension and diabetes mellitus. Glasgow's score upon entrance was 8, while the SOFA score was 3.\u003c/p\u003e \u003cp\u003eLaboratory tests on admission: leukocytes 10.14\u0026times;10^9/L, absolute neutrophils 6.41\u0026times;10^9/L, hemoglobin 95 g/L, platelets 348\u0026times;10^9/L. C-reactive protein (CRP) 115.99 mg/L, procalcitonin 0.15 ng/mL, hemosiderin 86 mm/1h, ferritin 850.88ug/L. Cardiac ultrasound (US) showed mild aortic stenosis with mild insufficiency of closure, left atrial and left ventricular enlarged. MRI of both hips suggests septic osteomyelitis. Cephalic MRI indicated that left basal ganglia signal not excluding cerebral infarction.\u003c/p\u003e \u003cp\u003eFollowing admission, the patient's four blood cultures were all negative. Next-generation sequencing (NGS) of whole blood and stool culture both yielded negative results. Widal reaction: \u003cem\u003eS. typhi\u003c/em\u003e: 1:640 (reference: 0\u0026ndash;1:80), \u003cem\u003eS. typhi\u003c/em\u003e: 1:320 (reference: 0\u0026ndash;1:160). We empirically applied CRO (ceftriaxone) (2.0 g, QD), however, the temperature and inflammatory parameters didn\u0026rsquo;t improve. 3 days later, the antibiotic was upgraded to meropenem (2.0 g, Q8H) in conjunction with the blood culture sensitivity test at the outside hospital, the patient's temperature returned to normal, and the inflammatory parameters improved significantly.\u003c/p\u003e \u003cp\u003eHowever, 3 days after applying meropenem, the patient developed fever again, with a higher white blood cell count of 14.31\u0026times;10^9/L. The possibility of exacerbating septic osteomyelitis or developing additional lesions was evaluated. Repeated US of the hip joint revealed that the effusion had not increased significantly compared to before, that the site was quite deep, and that it was still impossible to puncture and extract pus; at this point, transesophageal echocardiography revealed that the aortic valve had increased echogenicity and thickening, that the surface was rough, and that the opening was mildly restricted, and that the aortic valve vegetation had formed. Infective endocarditis was confirmed, and meropenem was maintained.\u003c/p\u003e \u003cp\u003eAfter 4 weeks, the patient's awareness improved, and her body temperature returned to normal, and the inflammatory parameters were clearly lowered, then she received anti-infective therapy at a local hospital for 1 month. Follow-up hip MRI and cardiac US were improved, the head MRI revealed lesion shrinking, and meropenem was reduced to 1g, Q8H. She was discharged from the local hospital six weeks later, and was treated with chronic faropenem suppression by oral. The patient and her family expressed satisfaction with the entire treatment process. The Fig.\u0026nbsp;1 summarizes the entire course of the patient's onset.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSalmonella infections cause fever and slow pulse, with rare multi-organ involvement. Patients with Salmonella bacteremia may develop hard-to-diagnose migratory lesions. We reported a case of S. typhi affecting multiple organs (heart valves, bone marrow, brain, kidneys) to highlight the need for dynamic monitoring and awareness of multi-organ infections.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eS.\u003c/em\u003e infective endocarditis is rare and fatal, no standard treatment strategy has yet been established. Cheng et al. summarized typhoid and nontyphoid S. infective endocarditis reported from 1976-2014, the overall mortality rate was 42.5% (37/87) in 87 patients and decreased over time [1]. With advances in detection and standardization of treatment, the mortality rate of \u003cem\u003eS.\u003c/em\u003e infective endocarditis has been decreasing annually; therefore, we further summarized the characteristics, treatment regimens, and regressions of \u003cem\u003eS.\u003c/em\u003e infective endocarditis published in 2014-2024. to provide guidance for the clinical management of \u003cem\u003eS.\u003c/em\u003e infective endocarditis.\u003c/p\u003e\n\u003cp\u003eBetween 2014 and 2024, a total of 18 cases of S. infective endocarditis caused by typhoid and non-typhoid were searched, including the case that was described (Table 1). The most common infection was caused by S. enteritidis (55.6%). 12 of the patients were male, with a median age of 53 years old. A total of 11 patients (61.1%) were 50 years of age or older. 8 of the patients had heart disease, 4 had heart valve replacements, 6 had immune system disorders or diabetes, and just 1 patient had no underlying medical conditions.\u003c/p\u003e\n\u003cp\u003eTable 1. Clinical characteristics and regression of patients with endocarditis caused by typhoid and non-typhoidal Salmonella during 2014-2024.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"1084\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathogen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDetection method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y)/Sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnderlying disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvolved valve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProsthesis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther extraintestinal infections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic/ Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValvular Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eOrtiz et al. (2014)[2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enteritidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e73/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAsthma, hypertension, and replacements of both mechanical mitral and bioprosthetic aortic valves\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNausea, diarrhea, fevers, and weakness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eurinary tract infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eGEN + AZT (IV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eLagan\u0026agrave; et al. (2017)[3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enterica PT 35\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eAutopsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e75/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSystemic arterial\u003c/p\u003e\n \u003cp\u003ehypertension, psoriasis, AF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eEmesis, diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePulmonary and systemic embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePiyasiri et al. (2017)[4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. Paratyphi A\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e25/NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 4 weeks) \u0026rarr;AZM (oral, 1 week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eLam et al. (2018)[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enteritidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e55/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCongenital cardiomyopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral and aortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSplenic infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 6 weeks) \u0026rarr;TMP/SMX (oral, as chronic suppressive therapy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eRonson et al. (2018)[6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enterica serovar Typhi\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e20/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, headache and diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 6 weeks) \u0026rarr;CIP (oral, 6 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eDickter et al. (2019)[7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enterica serotype Mbandaka\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood and stool cultures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e69/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAbdominal aortic aneurysm, atrial septal defect status, SSS, primary myelofibrosis with JAK2 mutation, secondary acute myelogenous leukemia, GVHD, acute DVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAbdominal pain, diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valvular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 6 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eYoussef et al. (2019)[8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003etyphimurium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e36/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAIDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ecough, shortness of breath, fever, chills and night sweats, diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eEustachian valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 5 days)\u0026rarr;CIP (oral, 4 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eConnolly et al. (2021)[9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enteritidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eIn 50s/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAortic and mitral valve replacement, LIMA to LAD CABG, hypothyroidism, COPD, and lower limb vascular stents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFevers, rigors, dyspnoea, chest discomfort, cough with coryza, nausea,\u003c/p\u003e\n \u003cp\u003evomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO+CIP (6 weeks)\u0026rarr; medium to long-term suppressive antibiotics to prevent relapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eDhayhi et al. (2021)[10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enterica subspecies\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003esalamae (subgroup II)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, jaundice, abdominal\u003c/p\u003e\n \u003cp\u003epain, and respiratory distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eInferior vena cava-right atrium junction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCIP + CTX (IV, 6 weeks)\u0026rarr;AM (2 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eMishra et al. (2021)[11]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. species\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eserotype O\u0026amp;H\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e50/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eChest pain, fever and altered mental status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eFEP (IV, 6 weeks) + LEV (oral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eAlhamadh et al. (2022)[12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS\u003c/em\u003e\u003cem\u003e. (group C and D)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e56/M\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eT2DM, hypertension, chronic anemia, AF, non-ICM, and RHD status post mitral and aortic valves replacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, chills, rigors, cough and mild shortness of breath.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSplenic infarction, aortic pseudoaneurysm and acute kidney injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO + GEN (IV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eYes (Commando surgery)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eRzucidło-Resil J et al. (2022)[13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enterica\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e39/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral and aortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSplenic infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO + TMP/SMX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eYes (cardiac transplantation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eMurray et al. (2023)[14]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. enteritidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture and WGS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e26/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHIV and HCV, regular injection drug use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, cough and dyspnoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMitral valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eEmbolization and acute arterial\u003c/p\u003e\n \u003cp\u003eocclusion of the left arm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eAMP + CIP (6 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eYes (mitral valve replacement)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003evan Kruijsbergen et al. (2023)[15]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eNon-(para)typhi\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSalmonella group D strain\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eIn 80s/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCKD, COPD and TAVI\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, lower abdominal pain and diarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO (IV, 6 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eWinicki et al. (2023)[16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. typhimurium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e57/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDrug use history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eDiarrhea, nausea, chills, and oliguria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO + LEV (6 weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eZahoor et al. (2023)[17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella typhi.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eBlood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e25/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eCough, fever, shortness of breath, and hemoptysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCRO + meropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eAlqallaf et al. (2024)[18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eSplenic abscess pus culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIHD, T2DM, hypertension, and CKD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eFever, crampy left sided abdominal pain, and irritability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eAortic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003esplenic infarction, and abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e45 days of ceftriaxone and two weeks of gentamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAbbreviations: AZT, aztreonam; AZM, azithromycin; AML, acute myelogenous leukemia; AIDS, acquired immunodeficiency syndrome; AF, atrial fibrillation; CRO, ceftriaxone; AM, amikacin; COPD, chronic obstructive pulmonary disease; CIP, ciprofloxacin; CTX, cefotaxime; CKD, chronic kidney disease; CABG, coronary artery bypass grafting; DVT, deep vein thrombosis; FEP, cefepime; GVHD, graft-versus-host disease; GEN, gentamicin; ICM, ischemic cardiomyopathy; IHD, ischemic heart disease; LIMA, left internal mammary artery; LAD, left anterior descending; LEV, levofloxacin; SLE, systemic lupus erythematosus; S., salmonella; SSS, sick sinus syndrome; SCA, sickle cell anemia; SMX, sulfamethoxazole; T2DM, type 2 diabetes mellitus; TAVI, transcatheter aortic valve implantation; TPM, trimethoprim; WGS, whole genome sequencing.\u003c/p\u003e\n\u003cp\u003eRemarkably, of the seven patients under 50 years of age, one was a 7-year-old child whose onset of disease might have been due to the presence of SCA, the other 6 patients were between 20 and 39 years of age, and 2 of them were HIV positive. The other 4 patients did not disclose any underlying illnesses or immunocompromise. This means that even previously healthy individuals with Salmonella infection can develop infective endocarditis, so careful monitoring of patients for any health changes is needed.\u003c/p\u003e\n\u003cp\u003eThe prodromal symptoms of infective endocarditis are atypical; the most common symptoms are fever (88.9%) and gastrointestinal symptoms (61.1%), and the cardiac valves involved include mitral valve (50%), aortic valve (50%), eustachian valve (5.6%) and inferior vena cava-right atrium junction (5.6%). 8 patients combined with other extra-intestinal complications, with splenic infarction being the most prevalent (4/8). The majority of patients were treated conservatively (83.3%) and most received third-generation cephalosporins (15/18), which were generally applied for 6 weeks. Half of the patients got combinations, and 5/18 patients had persistent suppressive treatment with medium- and long-acting antibiotics. Three individuals died ultimately, with a mortality rate of 16.7%. All three patients were old with underlying cardiac illness, and two had previously undergone heart valve replacement.\u003c/p\u003e\n\u003cp\u003eThe mortality rate of \u003cem\u003eS.\u003c/em\u003e infective endocarditis was approximately the same compared to cases in the previous decade (13.3% vs. 16.7%), and with the better understanding of \u003cem\u003eS.\u003c/em\u003e endocarditis, more and more \u003cem\u003eS.\u0026nbsp;\u003c/em\u003eendocarditis has been reported, with third-generation CROs and quinolone\u003cem\u003es\u0026nbsp;\u003c/em\u003eremaining the standard treatment options.\u003c/p\u003e\n\u003cp\u003eDiagnosing S. infection is challenging due to nonspecific early symptoms like fever and joint pain, antibiotic overuse, and difficulty obtaining biopsies. Once diagnosed, antibiotics should be started immediately based on sensitivity tests and clinical experience. Treatment duration should be extended for migratory lesion infections. Patients should be closely monitored for temperature, consciousness, and inflammatory markers, and antibiotics adjusted as needed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case involves a variety of complex diseases and complications, such as septic osteomyelitis and infective endocarditis, and thus holds significant value for medical education. Although the patient\u0026apos;s condition was described in detail, there may still be information that was not discovered or not recorded, which could affect the comprehensive understanding of the entire case. Typhoid can cause rare but serious complications. Fever patients should get blood cultures quickly. Even if results are negative, watch closely and consider complications. Treat with long-term IV antibiotics and surgery if needed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMRI magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eSOFA sequential Organ Failure Assessment\u003c/p\u003e\n\u003cp\u003eUS Cardiac ultrasound\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNGS Next-generation sequencing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRO ceftriaxone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAZT aztreonam\u003c/p\u003e\n\u003cp\u003eAZM azithromycin\u003c/p\u003e\n\u003cp\u003eAML acute myelogenous leukemia\u003c/p\u003e\n\u003cp\u003eAIDS acquired immunodeficiency syndrome\u003c/p\u003e\n\u003cp\u003eAF atrial fibrillation\u003c/p\u003e\n\u003cp\u003eCRO ceftriaxone\u003c/p\u003e\n\u003cp\u003eAM amikacin\u003c/p\u003e\n\u003cp\u003eCOPD chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eCIP ciprofloxacin\u003c/p\u003e\n\u003cp\u003eCTX cefotaxime\u003c/p\u003e\n\u003cp\u003eCKD chronic kidney disease\u003c/p\u003e\n\u003cp\u003eCABG coronary artery bypass grafting\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDVT deep vein thrombosis\u003c/p\u003e\n\u003cp\u003eFEP fluorinated ethylene propylene\u003c/p\u003e\n\u003cp\u003eGVHD graft-versus-host disease\u003c/p\u003e\n\u003cp\u003eGEN gentamicin\u003c/p\u003e\n\u003cp\u003eICM ischemic cardiomyopathy\u003c/p\u003e\n\u003cp\u003eIHD ischemic heart disease\u003c/p\u003e\n\u003cp\u003eLIMA left internal mammary artery\u003c/p\u003e\n\u003cp\u003eLAD left anterior descending\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLEV levofloxacin\u003c/p\u003e\n\u003cp\u003eSLE systemic lupus erythematosus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSSS sick sinus syndrome\u003c/p\u003e\n\u003cp\u003eSCA sickle cell anemia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSMX sulfamethoxazole\u003c/p\u003e\n\u003cp\u003eT2DM type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003eTAVI transcatheter aortic valve implantation\u003c/p\u003e\n\u003cp\u003eTPM trimethoprim\u003c/p\u003e\n\u003cp\u003eWGS whole genome sequencing\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLou Lixin and Li Fangqi are responsible for writing the manuscript. Qian Bo is in charge of the tables and illustrations. Zhang Kaiyu is responsible for the review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by Jilin Provincial Department of Science and Technology ( 20200201616JC) to KZ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript. The corresponding author, Kaiyu Zhang, can be contacted to obtain the raw data. Her email is [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of the First Hospital of Jilin University. Written informed consent was obtained from each individual.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this Case report and any accompanying images.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCheng WL, Li CW, Li MC, Lee NY, Lee CC, Ko WC. Salmonella infective endocarditis. J Microbiol Immunol Infect. 2016;49(3):313\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrtiz D, Siegal EM, Kramer C, Khandheria BK, Brauer E. Nontyphoidal cardiac salmonellosis: two case reports and a review of the literature. Tex Heart Inst J. 2014;41(4):401\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagan\u0026agrave; P, Delia S, Dattilo G, Mondello C, Ventura Spagnolo E. A case of Infective Endocarditis due to Salmonella enterica phagetype 35. First report. Clin Ter. 2017;168(6):e397\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePiyasiri DL, Chandrasiri P, Jayasinghe HS, Pathirage S, Sapukotana PM, Gamage TS. Salmonellosis beyond the gastrointestinal tract: a case series. Ceylon Med J. 2017;62(4):240\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam PW, Tumarkin E, Bogoch II. Medical management of Salmonella enteritidis prosthetic valve endocarditis with multiple infectious foci. Infection. 2018;46(3):435\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobson C, O'Sullivan MVN, Sivagnanam S. Salmonella enterica Serovar Typhi: An Unusual Cause of Infective Endocarditis. Trop Med Infect Dis 2018, 3(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDickter JK, Cai L, Snyder DS. Endocarditis following Consumption of Cereal Associated with Salmonella enterica Subtype Mbandaka Outbreak. \u003cem\u003eCase Rep Infect Dis\u003c/em\u003e 2019, 2019:5464230.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoussef D, Marroush TS, Tanveer F. A case report of eustachian valve endocarditis due to Salmonella typhimurium in an AIDS patient. Germs. 2019;9(3):154\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnolly G, Kale M, Ustianowski A. Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis. BMJ Case Rep 2021, 14(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhayhi NS, Shamakhi AE, Hakami MH, Alluli HM, Bahkly TN, Faqehi HH, Alqahtani HM, Alsum A, Ezadeen HH. Rare presentation of infective endocarditis due to Salmonella entrica subspecies salamae (subgroup ll) in a sickle cell anemia girl. IDCases. 2021;25:e01184.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMishra K, Cu C, Abolbashari M, Ojha CP, Cervantes JL, Alkhateeb H. Slither Into the Heart: Salmonella Endocarditis Following Rattlesnake Meat Ingestion. Cureus. 2021;13(7):e16466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhamadh MS, Alanazi RB, Alhowaish TS, Alhabeeb AY, Algarni ST, Wadaan OM, Suliman I, Al-Ghamdi MG. Refractory Salmonella Prosthetic Valve Endocarditis Complicated by Splenic Infarction and Aortic Pseudoaneurysm in a Patient with Double Prosthetic Valves: A Case Report. Diagnostics (Basel) 2022, 12(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRzucidło-Resil J, Golińska-Grzybała K, Przybylski R, Kapelak B, Gajos G, Gackowski A. A complicated course of Salmonella endocarditis leading to heart transplantation. Kardiol Pol. 2022;80(9):945\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray L, Venter M, Le Grange M, Meel R. Non-typhoid Salmonella endocarditis complicated by cardiac failure and acute limb ischaemia in a person living with HIV and hepatitis C: A case report and literature review. IDCases. 2023;32:e01747.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Kruijsbergen BWA, Spiegelenberg JP, van Lieshout M, Heuvelmans M. Non-typhoidal Salmonella enteritidis prosthetic valve endocarditis. BMJ Case Rep 2023, 16(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinicki NM, Desai D, Desai A, Perswani P, Smadi KA, Doyle K, Gandhi H, Sethi PS, Mukherjee A. From Gut to Heart': A rare case of Salmonella Typhimurium Bacteremia and native valve endocarditis. IDCases. 2023;32:e01787.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZahoor M, Ahmad K, Kakakhel M, Yousaf A, Saleh M, Sayyar M, Ali Y. Multidrug-Resistant Salmonella Endocarditis of a Native Valve: A Rare Case Presentation. Cureus. 2023;15(11):e48396.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlqallaf ZY, Maadarani OS, Elhabibi ME, Abdelfatah M, Bitar ZI. Point of Care Ultrasound Used to Diagnose Nontyphoidal Endocarditis. Pocus j. 2024;9(1):29\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Salmonella Typhi, Osteomyelitis, Infective endocarditis, Widal reaction, Case report","lastPublishedDoi":"10.21203/rs.3.rs-6793263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6793263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 62-year-old Asian woman with multiple organ involvement due to Salmonella infection (including heart valves, bone marrow, and central nervous system) was reported. She initially presented with fever and hip pain, and blood cultures showed Salmonella infection. Her condition progressed to sepsis, septic shock, nephritis, osteomyelitis, and cerebral infarction. After admission, antibiotics were upgraded, but she later developed infective endocarditis, requiring long-term intravenous antibiotics and eventually oral Faropenem therapy. Timely blood cultures, lesion assessment, and antibiotic adjustments are crucial for managing Salmonella infections and improving outcomes. This case uniquely presents a 62-year-old Asian woman with rapid progression of Salmonella infection to multi-organ involvement including sepsis and cerebral infarction, rarely seen in adults.\u003c/p\u003e","manuscriptTitle":"Salmonella Typhi infective endocarditis combined with multiorgan infection in an elderly woman-A case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 09:30:54","doi":"10.21203/rs.3.rs-6793263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f74d894-33d3-4ab3-a831-e267ae53d0b7","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-14T03:38:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 09:30:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6793263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6793263","identity":"rs-6793263","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}