Detection of coexisting toxigenic Clostridium difficile and nontyphoidal Salmonella in a healthcare worker with diarrhea: A therapeutic dilemma


Amos Lal, Raul Davaro, Ajay Kumar Mishra, Kamal Kant Sahu, George M. Abraham


Clostridium difficile infection (CDI) and nontyphoidal Salmonella infection (NSI) have similar clinical manifestations and are seldom seen simultaneously. The decision-making in terms of antibiotic therapy becomes difficult when both the pathogens are isolated from the same patient. We describe a case of Clostridium difficile (CD) enterocolitis in a healthcare provider who concomitantly tested positive for nontyphoidal Salmonella. To the best of our knowledge after extensive literature review (English), this is only the fourth report highlighting this association. Although Salmonella is not a risk factor for CDI, it can cause intestinal inflammation and alteration in the intestinal flora. When two pathogens are isolated from the same patient, it is tempting to treat both with antibiotics as highlighted. When it involves healthcare workers, there is no difference in guidelines and should not be prescribed antibiotics with intent of reducing secondary transmission.

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