When Salmonella Strikes the Brain: A Systematic Review of Non-Typhoidal Salmonella Infections with Central Nervous System Involvement in Immunosuppressed Patients

TL;DR

This paper reviews rare brain infections caused by Salmonella in people with weakened immune systems, highlighting the importance of early diagnosis and treatment.

Contribution

The study systematically reviews non-typhoidal Salmonella CNS infections in immunosuppressed patients and presents a case illustrating corticosteroid-induced vulnerability.

Findings

CNS infections by non-typhoidal Salmonella are rare but severe in immunocompromised individuals.

Corticosteroid use can lead to systemic Salmonella spread despite controlled HIV infection.

Early diagnosis and multidisciplinary care improve outcomes in these patients.

Abstract

Central nervous system (CNS) infections caused by Salmonella species (spp.) are exceptionally rare in adults but are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Clinical presentation is often nonspecific, including fever, headache, or altered mental status, while imaging may demonstrate meningeal enhancement, abscesses, or cytotoxic lesions. We present a systematic review of non-typhoidal Salmonella spp. infections involving the CNS across various immunosuppressive contexts, illustrated by the case of a 38-year-old HIV-positive man with well-controlled infection. He developed disseminated Salmonella enterica infection, with bacteremia, septic arthritis, and ultimately corpus callosum involvement, following chronic self-administration of corticosteroids for cluster headaches. This case underscores that corticosteroid exposure can precipitate systemic dissemination even in patients with preserved CD4 counts. Although this condition carries a high risk of mortality, early recognition, targeted antibiotic therapy, and careful multidisciplinary management of underlying immunosuppression are critical to improving survival and minimizing neurological sequelae.

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