Salmonella choleraesuis septicaemia complicating rheumatic heart disease.

The first report of a case of human infection with Salmonella choleraesuis was made by Longcope in -1902.6 The clinical manifestations of infection with this organism have been described by Harvey,4 who reviewed the literature up to that date and added 21 cases of his own treated at the Johns Hopkins Hospital, and have been further elaborated by Saphra and Wassermann,'2 who identified the organism from 329 patients investigated at the New York Salmonella Centre. A septicaemic illness resembling typhoid is the commonest presentation; other features include respiratory infection, urinary tract infection and pyaemic localizations, such as osteomyelitis, pyogenic arthritis and psoas abscess. For a salmonella infection, diarrhoea is relatively uncommon; Saphra and Wassermann were able to culture the organism from the faeces in only 23 of their 329 cases. Occasionally it may complicate an infection with another organism, e.g. meningococcal meningitis8. 9 -and scarlet fever.7 A rare site of infection with Salmonella choleraesuis is the endocardium. Ten of the 329 patients reported by Saphra and Wassermann had bacterial endocarditis, and Rich and St. Mary," in reporting a case of their own, could find only I3 other examples in the literature. Indeed, the total number of cases of endocarditis due to all salmonellae published between the years 1929 and 1956 was only 24. Infection with Salmonella choleraesuis can occur on a heart valve previously damaged by acute rheumatism3 11 as a complication of syphilitic heart disease3 or on apparently healthy heart valves.'L It can also affect the coronary arteries, giving rise to arteritis and throm.bosis.1 The incidence of systemic infection with Salmonella choleraesuis in Great Britain is low. Laylee in I9576 could find only IZ previously reported cases in this country. A man with fatal septicaemia -due to this organism has recently been treated in the Royal Victoria Infirmary, Newcastle upon Tyne. He also had rheumatic heart disease.