The patient was hospitalized due to diarrhea, fever and vomiting since the previous day.
Blood count was 2,700 leukocytes/mm3 and PCR 190.9 mg/L. Febrile and metabolic acidosis were present.
Treatment was initiated with cefoxime, which was maintained for two days until transfer to the ICU of another care center.
She was discharged after 6 days.
Salmonella spp. developed in the coprocultive.
Both parents, a sister and the household counselor had diarrhea.
Two months prior to admission, they had acquired two water turtles in a free fair.
Both reptiles were coprocultured.
The aquarium was cleaned in the dishes, the same place where the infant's food was prepared.
Microbiological study
Deposition samples were taken from patients and pets.
The wooden torula is located in Cary Blair (BBL) transportation medium.
Samples were placed in Mac Conkey agar plates and SS agar plates (Bio-Mérieux) in an environmental atmosphere at 35°C.
Traditional biochemical tests and Gram-negative VITEK-ID identification card (Biomérieux) were used to study fungal colonies.
Susceptibility study to all Salmonella isolates was performed by disk diffusion according to document M100 S24 CLSI 2014.
The serogroup study was performed by agglutination reaction with polyvalent antiserum (Salmonella O: poly A-I & Vi, BD-Difco) and with specific group antisera.
Isolates were sent to the National Reference Laboratory (ISP) for serotyping and subtyping.
The latter was performed using the restriction enzyme Xbal, according to the standardized protocol PulseNX pulsaI OPS-CDC Atlanta 25 (EFCP) pulsed-field gel electrophoresis (EPCP).
Patterns were analyzed using Bionumerics biotactics program (Applyed Maths, USA).
Microbiological results
There was development of Salmonella spp. in the stools of the three infants and in the stools of two of the four turtles studied.
The infected pets corresponded to one turtle in case 2 and one in case 3.
In the first case, the patient's strain agglutinated with BD-Difco Salmonella O antiserum group C1 Factors 6.7.
In the second case, patient and turtle isolates agglutinated with BD-Difco Salmonella or antiserum group C2 Factors 6.8.
In the third case, it was not possible to serogroup, since the isolates only agglutinated with the polyvalent antiserum.
The strain of the first patient was identified as Salmonella Monteo; the isolates of the second child and its turtle corresponded to Salmonella Newport and those of the third patient and its turtle, Salmonella Pomona.
All strains were susceptible to ampicillin, cotrimoxazole, chloramphenicol and ciprofloxacin except in the second case, in which the strain showed intermediate susceptibility to this quinolone.
The results of the genetic study revealed that the two isolates from case 2 had an identical subtype called CL-NP-XBA-014 (100% similarity).
Both isolates from case 3 presented the Cl-Spm-Xba-001 subtype.
These findings confirmed the genetic link between the cases and pets.
