International Journal of Community Medicine and Public Health

Patel KP et al. Int J Community Med Public Health. 2021 Apr;8(4):2077-2080

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Review Article

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20211283

Breast abscess due to Salmonella species: a brief review of epidemiology, clinical manifestations, serological correlation and management

Kinjal P. Patel*, Rutuja Darne, Reshma Poojary, Virendra Kinjale

Department of Laboratory Medicine, Apoorva Diagnostics and healthcare, Thane, Maharashtra, India

Received: 02 December 2020

Accepted: 05 March 2021

*Correspondence:

Dr. Kinjal P. Patel,

E-mail: kinjal.1527@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Breast abscess due to Salmonella is an uncommon but well recognized extra-intestinal complication of enteric fever. Salmonella species is commonly identified as a gastrointestinal pathogen causing bacteremia but inappropriately treated cases can led to dissemination in multiple organ systems resulting in localized abscess formation. Case reports have been described in literature about extra-intestinal abscesses by both S. enterica serotype typhi and paratyphi. Whilst recently, there has been an upsurge in the frequency of case reports related to Salmonella breast abscess, reason may be due to emergence of resistant Salmonella strains. Usually uncomplicated abscesses show effective clearance with single course of oral antibiotic agents together with surgery. Reviews have recommended azithromycin as a drug of choice especially in the presence of fluoroquinolones resistance. So, acknowledging prevalence of breast abscess due to salmonella is utmost important.

Keywords: Breast, Abscess, Salmonella, Clinical features, Serology, Treatment

INTRODUCTION

Breast abscess is a localized, painful collection of purulent material in breast tissue mostly affecting women of reproductive age group. They are predominantly lactational but non-lactational abscesses are also seen in premenopausal older women. Although Staphylococcus aureus is the most common pathogen, other microorganisms can be found for example Streptococcus species, coagulase negative Staphylococcus and anaerobes such as Peptostreptococccus and Bacteroides.1 Recent studies and various case reports highlighting breast abscess due to Salmonella spp. has been noted. In developing countries where enteric fever is endemic, Salmonella should be considered one of the main causes of breast abscess and treatment line should be decided accordingly. This review aims to summarize the available various case reports studies related to breast abscess due to Salmonella spp.

EPIDEMIOLOGY OF BREAST ABSCESSES

Although Staphylococcus aureus is the commonest pathogen but the incidence of Salmonella breast abscesses have been reported in up to 0.9% of cases.2 Salmonella species are majorly responsible for significant morbidity and mortality in developing countries. It is capable of forming localized abscesses in various organs such as subcutaneous tissue, muscles and skin. The pathogenesis of is not well established but possible causes may be hematogenous route and lymphatic spread from gastrointestinal tract. The major risk factors are extremes of ages, immune suppression, underlying malignancy, intravenous drug abuse and previous trauma.3 On analyzing the literature available on breast abscesses due to Salmonella spp., it was noted that most of the patients were immunocompetent non lactating females between the age group of 23-45 years.4

Table 1: Reported cases of breast abscess due to Salmonella typhi and paratyphi.
Table reproduced from source PDF page 2

On Analyzing the incidence of breast abscess in typhoid patients has been observed as 0.3% in 1930 by Klose and Sebening and 0.5% in 1937 by Pezinski in a study of 1,196 cases of typhoid over a period of 2 years. Other authors have also reported similar cases of unilateral breast abscess due to Salmonella typhi as well as bilateral breast abscesses. Cases were also found from countries like france and USA (Table 1).4-18 Unlike Salmonella typhi, breast abscess due to Salmonella paratyphi is a rare complication of enteric fever. Fernando et al had reported the first case of recurrent breast abscess caused by Salmonella enterica serotype paratyphi A while Siddesh et al reported a chronic case of breast abscess by Salmonella Paratyphi A in India from Mysore. Ghadage et al had reported a case of recurrent breast abscess Salmonella paratyphi A in a 31 year old non lactating female.

Among non typhoidal salmonellae, Razeq et al and Edelstein et al had isolated Salmonella landweisser and Salmonella serogroup B respectively. Benwan et al reported a very rare serotype, Salmonella enterica serotype Poona, which was associated with erythema nodosum. Kumar et al reported a multidrug-resistant typhoid with breast abscess. Elumalai et al analyzed the fluoroquinolones resistance mechanism in S. typhi from a breast abscess case, which is rare and uncommon. The S. typhi isolate showed high level resistance to nalidixic acid; minimum inhibitory concentration (MIC) >512 μg/ml) and ciprofloxacin (MIC 8 μg/ml).11-18

Hence, any breast abscess in an immunocompetent female with or without a history of enteric fever and no other predisposing factors must be evaluated, keeping the possibility of a Salmonella breast abscess. The pus aspirated must be sent for bacteriological culture. If not done, such diagnosis could be easily missed.

CONCLUSION

This review highlights the need for understanding the local epidemiology of enteric fever and its complications. Complete assessment of the patient including breast imaging, microbiological culture, and drug susceptibility report are essential for appropriate management of rare complications of enteric fever like breast abscesses. Clinicians must be aware of the management and should make referrals for any patient for which resolution does not occur rapidly with a single course of antibiotic therapy. Delay in such issues can have serious consequences on residual morbidity.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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