|Year : 2012 | Volume
| Issue : 2 | Page : 109-111
A case of breast abscess due to Salmonella paratyphi A
G Siddesh1, MN Sumana2
1 Department of Surgery, JSS Medical College, Mysore, Karnataka, India
2 Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
|Date of Web Publication||27-Sep-2012|
M N Sumana
Department of Microbiology, JSS Medical College, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
Bacterial mastitis is the most common variety of mastitis and is often caused by Staphylococcus aureus. Chronic mastitis is usually caused by tuberculosis, syphilis and Mondor's disease. A 33-year-old female presented with lump in the right breast for the past two years with pain for the past 15 days and discharge for the past two to three days. There was no history of diabetes mellitus, hypertension, bronchial asthma and tuberculosis. On examination, the lump measured approximately 9×5 cm in size with a discharging sinus just lateral to the areola. No regional lymphadenopathy was noticed. A clinical diagnosis of "Lump in the right breast with sinus probably due to tuberculosis was made. The lump was excised and per-operative sample grew Salmonella paratyphi A in culture. She responded to Ceftriaxone and unnecessary use of anti-tubercular drugs could be avoided. In chronic mastitis and breast abscess Salmonella species should be considered as one of the etiological agents.
Keywords: Chronic breast abscess, Salmonella, lump in breast
|How to cite this article:|
Siddesh G, Sumana M N. A case of breast abscess due to Salmonella paratyphi A. Int J Health Allied Sci 2012;1:109-11
| Introduction|| |
Bacterial mastitis is the most common variety of mastitis. Lactational mastitis is most often caused by Staphylococcus aureus. Chronic inflammatory abscess follows usually inadequate drainage or injudicious use of antibiotic treatment or is due to tuberculosis, syphilis, or Mondor's disease. 
Non-lactational breast abscess occurs in patients with duct ectasia and periductal mastitis. Anaerobic bacteria are the cause in the majority of cases.  Although a few cases of breast abscess due to Salmonella More Details have been reported in the literature, it is a rarity. Hence we report this case of chronic non-lactational breast abscess due to Salmonella paratyphi A.
| Case Report|| |
A 33-year-old female presented to the outpatient department of Surgery with history of lump in the right breast for the past two years with pain in the lump for the past 15 days and discharge from the lump for the past two to three days.
Patient was apparently normal two years back and later noticed a lump associated with pain in her right breast that was circular, measuring about 5 cm. She consulted a doctor and the pain was relieved by medication. Since 15 days, she had noticed pain in the lump again, continuous in nature, pricking type and non-radiating. No variation was associated with the menstrual cycle. Patient complained of discharge from the lump for the past two to three days, purulent initially, later mixed with blood. There was no history of similar swelling in the other breast; no history of fever, and ulceration of the lump; no history of diabetes mellitus, hypertension, bronchial asthma and tuberculosis.
Patient was a middle-aged female, moderately built and nourished, alert, conscious and co-operative. No pallor, icterus, cyanosis, pedal edema and lymphadenopathy was seen. All other parameters were within normal limits. On local examination of the right breast, a lump was noticed that was oval in shape measuring approximately 9×5 cm in size, non-tender, and there was no focal rise in temperature. The surface of the swelling was smooth, firm in consistency with a well-defined margin. A discharging sinus was noticed just lateral to the areola with scanty purulent discharge. There was no regional palpable lymph node enlargement. Other systems examined revealed no clinical abnormality. A clinical diagnosis of "Lump in the right breast with sinus (? Tuberculosis)" was made. A swab collected from the discharging sinus was sent to the microbiology laboratory which yielded the growth of a few colonies of Pseudomonas which was regarded as a surface colonizer and the diagnosis of tuberculosis was still considered but Zeihl Neelson's staining did not reveal any acid-fast bacilli. Chest X-ray and ultrasound scanning of the abdomen did not reveal any abnormality and hence other systemic abnormality was ruled out.
Ultrasound scan of the breast revealed an organized collection in the right breast in the lateral aspect extending anteriorly up to the skin surface in the periareolar region with a few enlarged lymph nodes in the right axillary region. Human Immunodeficiency Virus (HIV) antibodies and Hepatitis B surface antigen were negative.
The patient was then posted for excision biopsy after taking written consent. The lump was excised and per-operative sample was sent for culture and sensitivity [Figure 1]. The sample was inoculated onto both MacConkey's agar and Blood agar plates and incubated at 37°C for 48 h. MacConkey's agar yielded non-lactose fermenting colonies which were processed as per the standard protocol. The biochemical reactions put up depicted the reactions of Salmonella paratyphi A. The identification was confirmed by doing slide agglutination test with specific antisera (O-2). Antisera were obtained from Omega Diagnostics Ltd. The antibiogram showed that the isolate was sensitive to Ciprofloxacin, Cefotaxime, Cotrimaxazole, Ceftriaxone and was resistant to Nalidixic acid and Ampicillin. The sample was also processed for mycobacterial culture on Lowenstein-Jenson (L-J) medium that was incubated at 37°C for eight weeks. Culture on L-J medium did not yield any growth. The sample was also negative for acid-fast bacilli in the direct smear.
Ten ml of blood sample was collected with aseptic precautions for culture, inoculated onto brain heart infusion broth and incubated for ten days with alternate day subculture to look for growth of Salmonella. Culture did not yield the growth of any bacteria after ten days of incubation.
The patient's blood sample was also tested for antibodies to Salmonella by Widal test and the antibody titers were TO < 1 in 40, TH < 1 in 40, AH= 1 in 160, and, BH < 1 in 40 suggestive of a chronic infection with Salmonella paratyphi A. Widal antigen was procured from Span Diagnostics Ltd.
Based on the culture report, the patient was started on Ceftriaxone and treated for two weeks and unnecessary use of anti-tubercular drugs could be avoided.
After three weeks the patient was reviewed and it was found that the discharging sinus had healed up with no fluid/pus collection.
| Discussion|| |
Although Salmonella isolated from different tissue sites have been reported in the literature, very few (only nine cases were found in the literature search) cases from breast abscess have been recorded.
Nada Brncic et al. have reported the isolation of S. enteritidis from a 70-year-old male patient with unilateral breast abscess.  Roopa Viswanathan et al. have reported the isolation of S. typhi from a 42-year-old non-lactating female patient with unilateral breast abscess.  Khalifa Al Benwan et al. have reported the isolation of S. typhi from a non-lactating female patient with bilateral breast abscess.  This patient had associated erythema nodosum. Singh et al. have reported isolating S. typhi from a 35-year-old non-lactating female patient with bilateral breast abscess.  Vattipally et al. have reported the isolation of S. typhi from a female non-lactating patient with bilateral breast abscess.  Delori et al. have reported the isolation of S. typhi from a 54-year-old non-lactating female patient with unilateral breast abscess.  Mahajan et al. have reported a case of unilateral breast abscess in an immunocompromised patient due to S. typhi.  Edelstein et al. have also reported on isolating S. typhi from a unilateral breast abscess in a non-lactating woman.  K Jayakumar et al. have also reported isolating S. typhi from unilateral breast abscess in a 40-year-old non-lactating woman. 
S. paratyphi A is known for milder form of enteric fever with not many complications associated.  This is the first case of breast abscess due to S. paratyphi A. Also, this patient did not have any present or past history of illness suggestive of enteric fever. Hence we thought it is worthwhile reporting this rare case of breast abscess due to S. paratyphi A.
Following are the case reports of Salmonella isolated from different tissues by different authors.
Zachee et al. have reported lung abscess due to non-typhoid Salmonella in immunocompromised host.  Arya et al. have reported pancreatic abscess caused by S. typhi. 
Raghunatha et al. have reported a case of injection abscess due to S. typhi.  Sinha et al. have reported a case of Salmonella typhi isolated from splenic abscess.  Hung et al. have reported pelvic abscess caused by Salmonella.  Barrett et al. have reported "a case of breast abscess: a rare presentation of typhoid".  MK Lalita et al. in their study from 6250 cases of Salmonellosis More Details have reported soft-tissue abscess in skin (7), parotid (2), thyroid (3), breast (1), inguinal node (1), bronchial sinus (1), and injection site (1).  There are innumerable reports on isolation of Salmonella from various sites other than the breast. Only few articles have been reviewed here.
Because of the rarity, this case of breast abscess due to Salmonella paratyphi A is reported. With culture report, unnecessary use of anti-tubercular drug could be avoided.
| Acknowledgment|| |
My sincere thanks to Prof. G.S.Vijay Kumar, HOD of Microbiology, who permitted me to work on this case.
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