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Salmonella breast abscess
I
Case Report consistent with several criteria for malignancy. Routine hematology and chemistry analyses were normal. A needle aspiration of the mass was performed, frank pus was withdrawn, and the patient was given cloxacillin. One week later due to enlargement of the mass, it was drained surgically. Both times pus was sent for Gram stain and culture. Gram stain revealed many polymorphonuclear leukocytes and many gram-negative bacilli. Cultures grew pure Salmonella enteritidis, serotype enteritidis. Stool culture was negative for Salmonella sp. The abscess resolved with drainage and treatment with oral amoxicillin for 4 weeks. The organism was lactose-negative on MacConkey agar; TSI showed an alkaline slant and acid butt with H2S. The API 20E strip (Analytab, Inc., Plainview, N.Y.) identified it as Salmonella enteritidis. The organism was susceptible to ampicillin, cephalexin, trimethoprim-sulfamethoxazole, tobramycin, and gentamicin. The organism was sent to the Quebec Provincial Laboratory for confirmation and serotyping. Breast infections occur most frequently in the postpartum state. Staphylococcus aureus is the most common cause and therefore a penicillinase-resistant penicillin is the treatment of choice. Breast abscess and mastitis due to Salmonella typhi has been reported as a rare presentation of typhoid fever
(1, 2). There has been one case report of a non-typhi Salmonella sp. causing mastitis during pregnancy (3). This case underscores the fact that empiric therapy without culture should not be given to patients with breast abscess, particularly those who are not puerperal. The source of this patient's infection is not known but it is possible that a cystic breast was seeded during a bacteremia associated with her previous gastroenteritis. Another important aspect of this case is the potential nosocomial transmission hazard of salmonella abscesses of the breast and other soft tissues because this organism is rarely suspected in these types of infections (4, 5).
The National Committee for Clinical Laboratory Standards (NCCLS) offers eight multiple standards reference volumes. These specialty collections provide the user with related NCCLS standards and guidelines in key subject areas. Two reference volumes are now available.
guidelines covering antimicrobial disk susceptibility testing, antimicrobial susceptibility testing for bacteria that grow aerobically and anaerobically, serum bactericidal testing, and bactericidal activity of antimicrobial agents. Two documents included in the collection are new. They are: Perfor-
gested groupings of antimicrobial agents for routine testing, detailed methods for susceptibility testing of
Antimicrobial Susceptibility Testing, Second Edition (SC3) provides the laboratorian with the NCCLS documents specifically designed for antimicrobial susceptibility testing. Included in this revised edition are standards and
mance Standards for Antimicrobial Disk Susceptibility Tests (M2-A4), and Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Anaerobically (M7-A2). The documents contain extensive revisions including: changes in the table on sug-
Salmonella Breast Abscess Ruth Horn, M.D. Microbiology Department Royal Victoria Hospital Montreal, Quebec H3A 1A1 A 29-year-old woman in previously good health was referred to a surgeon in our hospital for a left breast m a s s . The patient was single and had never been pregnant. Two months prior to this referral she had been on vacation in Virginia Beach, Virginia. At that time s h e had a one-week illness consisting of vomiting and watery diarrhea without blood or mucus. One month later she developed left third intercostal pain and was given a muscle relaxant. Over the next 4 weeks she felt a small lump in the same area that progressively enlarged to involve the left breast and became very hard and slightly tender. She had no fever nor discharge from the nipple. On examination, the patient was a healthy appearing young woman. Physical examination was unremarkable except for a hard, tender, 10 × 6 cm oval mass in the medial left breast. A mammogram was reported as showing dense fibrocystic parenchyma without a localized mass and to have poor readability. A thermogram was very abnormal and gave the highest reading
References 1. Barrett, G. S. and J. MacDermot. 1972. Breast abscess: a rare presentation of typhoid. Br. Med. J. 2:628629. 2. Campbell, F, C., B. L. Eriksson, and I. B. Angome. 1979. Localized granulomatous mastitis--an unusual presentation of typhoid. S. Afr. Med. J. 57:793-795. 3. Stamm, A. 1982. Salmonella bredeney mastitis during pregnancy. Obstet. Gynecol. 59 (suppl.):295-305. 4. Gremellion, D. H., R. Geckler, and C. Ellenbogen. 1977. Salmonella abscess, a potential nosocomial hazard. Arch. Surg. 112:843-845. 5. Rao, R. S. and S. Sharma. 1984. Uncommon manifestations of salmonellosis. Indian J. Med, Sci. 38:250-253.
NCCLS News
Clinical Microbiology Newsletter 12:22,1990
© 1990 Elsevier Science Publishing Co., Inc.
Neisseria gonorrhoeae and Haemophilus, improved consistency between the MIC interpretive standards in M7-A2 (dilution method) and equivalent breakpoints based on zone diameter interpretive standards in M2-A4 (disk method), and specific recommended methods for 13-1actamase testing as well as a screening test for oxacillin resistance. The documents contained in the Anti-
0196-4399/90/$0.00 + 02.20
175
Case Report consistent with several criteria for malignancy. Routine hematology and chemistry analyses were normal. A needle aspiration of the mass was performed, frank pus was withdrawn, and the patient was given cloxacillin. One week later due to enlargement of the mass, it was drained surgically. Both times pus was sent for Gram stain and culture. Gram stain revealed many polymorphonuclear leukocytes and many gram-negative bacilli. Cultures grew pure Salmonella enteritidis, serotype enteritidis. Stool culture was negative for Salmonella sp. The abscess resolved with drainage and treatment with oral amoxicillin for 4 weeks. The organism was lactose-negative on MacConkey agar; TSI showed an alkaline slant and acid butt with H2S. The API 20E strip (Analytab, Inc., Plainview, N.Y.) identified it as Salmonella enteritidis. The organism was susceptible to ampicillin, cephalexin, trimethoprim-sulfamethoxazole, tobramycin, and gentamicin. The organism was sent to the Quebec Provincial Laboratory for confirmation and serotyping. Breast infections occur most frequently in the postpartum state. Staphylococcus aureus is the most common cause and therefore a penicillinase-resistant penicillin is the treatment of choice. Breast abscess and mastitis due to Salmonella typhi has been reported as a rare presentation of typhoid fever
(1, 2). There has been one case report of a non-typhi Salmonella sp. causing mastitis during pregnancy (3). This case underscores the fact that empiric therapy without culture should not be given to patients with breast abscess, particularly those who are not puerperal. The source of this patient's infection is not known but it is possible that a cystic breast was seeded during a bacteremia associated with her previous gastroenteritis. Another important aspect of this case is the potential nosocomial transmission hazard of salmonella abscesses of the breast and other soft tissues because this organism is rarely suspected in these types of infections (4, 5).
The National Committee for Clinical Laboratory Standards (NCCLS) offers eight multiple standards reference volumes. These specialty collections provide the user with related NCCLS standards and guidelines in key subject areas. Two reference volumes are now available.
guidelines covering antimicrobial disk susceptibility testing, antimicrobial susceptibility testing for bacteria that grow aerobically and anaerobically, serum bactericidal testing, and bactericidal activity of antimicrobial agents. Two documents included in the collection are new. They are: Perfor-
gested groupings of antimicrobial agents for routine testing, detailed methods for susceptibility testing of
Antimicrobial Susceptibility Testing, Second Edition (SC3) provides the laboratorian with the NCCLS documents specifically designed for antimicrobial susceptibility testing. Included in this revised edition are standards and
mance Standards for Antimicrobial Disk Susceptibility Tests (M2-A4), and Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Anaerobically (M7-A2). The documents contain extensive revisions including: changes in the table on sug-
Salmonella Breast Abscess Ruth Horn, M.D. Microbiology Department Royal Victoria Hospital Montreal, Quebec H3A 1A1 A 29-year-old woman in previously good health was referred to a surgeon in our hospital for a left breast m a s s . The patient was single and had never been pregnant. Two months prior to this referral she had been on vacation in Virginia Beach, Virginia. At that time s h e had a one-week illness consisting of vomiting and watery diarrhea without blood or mucus. One month later she developed left third intercostal pain and was given a muscle relaxant. Over the next 4 weeks she felt a small lump in the same area that progressively enlarged to involve the left breast and became very hard and slightly tender. She had no fever nor discharge from the nipple. On examination, the patient was a healthy appearing young woman. Physical examination was unremarkable except for a hard, tender, 10 × 6 cm oval mass in the medial left breast. A mammogram was reported as showing dense fibrocystic parenchyma without a localized mass and to have poor readability. A thermogram was very abnormal and gave the highest reading
References 1. Barrett, G. S. and J. MacDermot. 1972. Breast abscess: a rare presentation of typhoid. Br. Med. J. 2:628629. 2. Campbell, F, C., B. L. Eriksson, and I. B. Angome. 1979. Localized granulomatous mastitis--an unusual presentation of typhoid. S. Afr. Med. J. 57:793-795. 3. Stamm, A. 1982. Salmonella bredeney mastitis during pregnancy. Obstet. Gynecol. 59 (suppl.):295-305. 4. Gremellion, D. H., R. Geckler, and C. Ellenbogen. 1977. Salmonella abscess, a potential nosocomial hazard. Arch. Surg. 112:843-845. 5. Rao, R. S. and S. Sharma. 1984. Uncommon manifestations of salmonellosis. Indian J. Med, Sci. 38:250-253.
NCCLS News
Clinical Microbiology Newsletter 12:22,1990
© 1990 Elsevier Science Publishing Co., Inc.
Neisseria gonorrhoeae and Haemophilus, improved consistency between the MIC interpretive standards in M7-A2 (dilution method) and equivalent breakpoints based on zone diameter interpretive standards in M2-A4 (disk method), and specific recommended methods for 13-1actamase testing as well as a screening test for oxacillin resistance. The documents contained in the Anti-
0196-4399/90/$0.00 + 02.20
175