# Concomitant Salmonella and Leptospira Meningitis: A Rare Case Report

## TL;DR

A 20-year-old woman in Pakistan was diagnosed with rare simultaneous meningitis caused by Salmonella and Leptospira, highlighting the need for comprehensive diagnosis in endemic regions.

## Contribution

This case report documents a rare concurrent infection of Salmonella and Leptospira meningitis in a previously healthy adult.

## Key findings

- The patient exhibited symptoms including high fever, confusion, and a seizure, with confirmed Salmonella typhi and leptospiral antibodies.
- MRI confirmed leptomeningeal enhancement, and treatment with azithromycin, meropenem, and ceftriaxone improved the patient's condition.
- The case underscores the importance of considering multiple pathogens in diagnostic evaluations in regions where these infections are endemic.

## Abstract

This study presents a unique case of concurrent salmonella and Leptospira meningitis in a 20-year-old woman with no prior medical history. Coinfection with endemic pathogens is plausible, especially in regions like Pakistan. While Salmonella meningitis is uncommon, it presents a significant medical emergency, particularly in immunocompromised adults. Neuroleptospirosis, though rare, can manifest in certain cases. The patient displayed persistent high fever, confusion, irritability, and a single seizure episode. Initial tests, including blood and cerebrospinal fluid (CSF) cultures and serological examinations, detected Salmonella typhi and positive leptospiral antibodies, respectively. Leptomeningeal enhancement was confirmed by an MRI. Treatment with azithromycin, meropenem, and ceftriaxone led to improvement after seven days. She was advised to complete a 28-day course for Salmonella meningitis. This case emphasizes the importance of considering multiple infectious causes, especially in endemic regions. Timely and thorough diagnostic evaluation, followed by appropriate antimicrobial therapy, is essential for effective management. Further research is warranted to enhance understanding of the epidemiology, clinical features, and optimal treatment strategies for such dual infections.