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Fever of Unknown Origin Owing to Salmonellosis with Nalidixic Asid Resistant Salmonella Schottmuelleri: A Case Report

Bircan Kayaaslan, Pınar Önügürü, Ahmet Sertcelik, Aliye Bastug, Ipek Mumcuoglu, Halide Aslaner, Ayse But, Selim Sırrı Eren, Meltem Arzu Yetkin, Esragul Akinci, Hurrem Bodur.

Abstract
Resistance to fluoroquinolones is a rare situation in Salmonella strains. We report here a case of fluoroquinolone-resistant Salmonella schottmuelleri which caused a confusion in the diagnosis. Forty years-old female was admitted to our clinic with a 19 day-history of fever. The patient had applied to another hospital five days ago and had been given ciprofloxacin. In our hospital, her blood Gruber-Widal test showed a titer of 1/200 against BO and BH antigens. However, because the patient was unresponsive to ciprofloxacin, this result was ignored and specific antibiotic therapy was not started. Later, Salmonella schottmuelleri was isolated in bone marrow culture, but blood cultures were negative. The isolate was resistant nalidixic acid, susceptible to ciprofloxacin and ceftriaxone. Ceftriaxone was begun. After three days, fever disappeared. The purpose of this report is to emphasize the probability of quinolone resistant salmonella strains in the differential diagnosis of fever of unknown origin and to call attention to ineffectiveness of ciprofloxacin even tough seems to be susceptible in vitro.

Key words: Salmonella schottmuelleri; Nalidixic Acid Resistant Fever; Fever of Unknown Origin



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