positive blood culture for salmonella

[newfoundjoy]

My son's health case has quite a bit of history. Back in August we took him to the family doctor. He had swollen lymph nodes on both sides of the neck just below the jawbone. The glands had actually increased and decreased within the year. They did some bloodwork on him, and found that he had at some point in time had mononucleosis, and that his blood platelette count was high. The doctor decided to send us to an ent, who suggested a lymphnode biopsy be done. Test results all came back normal fromt he biopsy. Two weeks after his surgery, his neck abcessed out, and we were back in the hospital. They opened up the wound, drained it, and kept him for 3 days on i.v. antibiotics. All was going well, but after about 4 weeks, the surgical area became red and swollen again. He was put on antibiotics again, and blood was taken again. This time the test is showing positive for salmonella 0 type vi, and his titer was 1/160. The ent does not know anything about salmonella, so he sent us to a pediatrician. He is suggesting that we see a infectious disease specialist. But, he said that you cannot trust blood culture for showing a true positive salmonella result. I am just a worried mom who needs some answers. My son does not have diarrhea, but is unusually tired, and has been for a long time. He also has frequent headaches, eye pains, and leg pains. We spend alot of time with a heating pad on his legs. Please let me know your opinion on the blood culture. Also, fyi, we are going to have a stool culture done. This is the only test that he has not had done yet.
Thank You!

[John Kenyon, CNA]

Hello -

It would seem your son has had a particularly nasty bout with infectious mononucleosis with extensive lymph node involvement. Since mono can be rather insidious at times and missed entirely until some cause for blood work reveals the antibody, it can, in some cases, linger, as can the enlarged lymph nodes. This can, rarely, cause a compromise (temporary) of the patient's immune system, during which time opportunistic infections such as varieties of salmonella and other farily common and short-lived bacteria can establish themselves in the bloodstream, causing symptoms different from what one might ordinarily expect. This could be the case with your son. If this is the case, prolonged antibiotic therapy might be required, but first the infection must be positively identified, so an infection disease specialist would certainly be appropriate for ruling this in or out. If the infection winds up being ruled out, then your son will require additional testing to determine what's going on with his lymph system, as there are a few disease processes which can also find a home there, and they are serious enough to warrant tests for problems other than simple infection. Hopefully the salmonella will prove to be the culprit, as it is easier to treat, although when systemic, as this instance would appear to be, it can be more stubborn than when confined to the digestive tract.

Please update us once your son has been studied further, or if you have any new information or questions. Best of luck to you and your son. Hopefully this will resolve soon.