Nontyphoidal salmonella intracranial infections in HIV-infected patients

Salmonella focal intracranial infections are unusual in human immunodeficiency virus (HIV)-infected patients. Six such infections have been reported in the world literature. We report a case of salmonella subdural and epidural cerebral empyema with concomitant osteomyelitis of the frontal bone. Such a complication in the course of salmonellosis is reported for the first time. In previously published case reports, four patients had brain abscess and two had subdural empyema. Salmonella typhimurium was isolated from two patients, and different serotypes were recovered from the others. All patients had advanced HIV disease, and all but two had had opportunistic infections before the diagnosis of salmonella intracranial infection. Surgical drainage combined with systemic antibiotic therapy resulted in the recovery of four of five patients. No regression of the lesions occurred in one patient treated only with antibiotics for multiple cerebral abscesses.